Workflow and decision making of operating room nurses: integrative review

Integrative review of the literature conducted through searches in the databases: Latin American and Caribbean Literature in Health Sciences; Nursing Database; Pubmed; Scopus and Cumulative Index to Nursing and Allied Health Literature. The results were organized into factors related to positive, negative and positive and negative implications.

Results:

The sample of 18 articles included examples of factors with positive implications, such as preoperative data collection, negative outcomes, such as lack of human, material and structural resources, and positive and negative outcomes, as preparation for certification.

Conclusions:

Factors that influence the decision-making process of nurses are associated to different conditions: client- related conditions and those conditions that go beyond the domain and organization of the surgical environment.

Keywords
Operating room nursing; Workflow; Decision making

Country of origin/year of publication	Type of study/ level of evidence	Factor	Implications
Article88. McGarry JR, Pope C, Green SM. Perioperative nursing: maintaining momentum and staying safe. J Res Nurs. 2018;23(8):727-39. doi: https://doi.org/10.1177/1744987118808835 https://doi.org/10.1177/1744987118808835... England 2018	Descriptive, qualitative/VI	Emergency surgeries	Cancellation of surgeries Late shift work Internal groups examining cancellations
		Lack or unavailability of equipment
		Client not ready for the ward, or client cannot return to the ward, or staff not ready to receive the client in the ward
		Lack of vacant beds in the immediate post-anesthetic recovery room
		Delayed surgeries
Article1010. Bayramzadeh S, Joseph A, San D, Khoshkenar A, Taaffe K, Jafarifiroozabadi R, et al. The impact of operating room layout on circulating nurse's work patterns and flow disruptions: a behavioral mapping study. Herd. 2018;11(3):124-38. doi: https://doi.org/10.1177/1937586717751124 https://doi.org/10.1177/1937586717751124... USA 2018	Descriptive, quantitative/VI	Excessive movement of the circulating nurse	Increased time spent on each activity of the circulating nurse due to the distance between the areas of the operating room, interrupting the workflow of surgical procedures
Article1313. Sampaio CEP, Gonçalves RA, Seabra Júnior HC. Determination of surgery suspension factors and their constributions with nursing assistance. Rev Pesq Cuid Fundam. 2016;8(3):4813-20. doi: https://doi.org/10.9789/2175-5361.2016.v8i3.4813-4820 https://doi.org/10.9789/2175-5361.2016.v... Brazil 2016	Descriptive, quantitative/VI	Lack of human, material and structural resources	Cancellation of surgeries
	Descriptive, quantitative/VI	Client's clinical conditions	Cancellation of surgeries
Article1414. Calebrant H, Sandh M, Jansson I. How the nurse anesthetist decides to manage perioperative fluid status. J Perianesth Nurs. 2016;31(5):406-14. doi: https://doi.org/10.1016/j.jopan.2015.04.005 https://doi.org/10.1016/j.jopan.2015.04.... Sweden 2016	Descriptive, qualitative/VI	Data collected in the preoperative period	Establishment of communication with the anesthetist Meeting the client's fluid therapy needs
	Descriptive, qualitative/VI	Detection of the client's clinical changes during the operation
Article1515. Xiang W, Yin J, Lim G. A short-term operating room surgery scheduling problem integrating multiple nurses roster constraints. Artif Intell Med. 2015;63(2):91-106. doi: https://doi.org/10.1016/j.artmed.2014.12.005 https://doi.org/10.1016/j.artmed.2014.12... China 2015	Descriptive, quantitative/VI	Use of computational algorithm for surgical programming	Improvement of surgical programming and allocation of materials and human resources
Article1616. Jacques JPB, Ribeiro RP, Martins JT, Rizzi DS, Schimidt DRC. Geradores de estresse para os trabalhadores de enfermagem de centro cirúrgico. Semina Cienc Biol Saúde. 2015;36(Supl 1):25-32. doi: https://doi.org/10.5433/1679-0367.2015v36n1Suplp25 https://doi.org/10.5433/1679-0367.2015v3... Brazil 2015	Descriptive, qualitative/VI	Lack of adequate time to carry out activities	Work overload, tiredness and stress
		Lack of materials and equipment
		Lack of planning and organization
		Lack of human resources
Article1717. Gaspar AF, Martone D, Carraro DC, Ferreira GSA, Ferreira Filho JA, Cardoso R, et al. Impacto da implantação de um novo modelo de gestão embasado em indicadores no bloco cirúrgico de um hospital universitário terciário. Medicina (Ribeirão Preto). 2015;48(1):33-40. doi: https://doi.org/10.11606/issn.2176-7262.v48i1p33-40 https://doi.org/10.11606/issn.2176-7262.... Brazil 2015	Descriptive, quantitative/VI	Adoption of a management model	Reduced length of stay in immediate post-anesthetic recovery Reduction in the number of suspended surgeries Reduced first surgery delay
Article1818. Fernandes HMLG, Peniche ACG. Perception of the nursing team of a surgical center regarding hospital accreditation at a university hospital. Rev Esc Enferm USP. 2015;49(esp):22-8. doi: https://doi.org/10.1590/S0080-623420150000700004 https://doi.org/10.1590/S0080-6234201500... Brazil 2015	Descriptive, quantitative/VI	Preparation for certification (acquisition of equipment, incorporation of security measures, compliance with bundles, elaboration of an annual training program, standardization of practices and conduct of the nursing team and adherence to the safe surgery protocol)	Better working conditions Increased staff stress
Article1919. Bezerra WR, Bezerra ALQ, Paranaguai TTB, Bernardes MJC, Teixeira CC. Occurrence of incidents at a surgical center: a documentary study. Rev Eletr Enferm 2015;17(4). doi: https://doi.org/10.5216/ree.v17i4.33339 https://doi.org/10.5216/ree.v17i4.33339... Brazil 2015	Descriptive, quantitative/VI	Lack of human resources and preoperative evaluation	Cancellation of surgeries
		Disorganization of the operating room	Reduced quality of care
		Technical failures of the professionals
		Poor quality devices and equipment
Article66. Santos FK, Silva MVG, Gomes AMT. Understanding the forms of care of nurses in the operating room - a construction based on the grounded theory method. Texto Contexto - Enferm. 2014;23(3):696-703. doi: https://doi.org/10.1590/0104-07072014001140013 https://doi.org/10.1590/0104-07072014001... Brazil 2014	Descriptive, qualitative/VI	Failure to communicate with management	Difficulty in the workflow Reduced quality of care
		Lack of provision of resources
		Excessive non-nursing tasks
Article55. Richa AC, Guimarães SM, Cardoso TV. Gestão por padronização de processos: a percepção dos enfermeiros de centro cirúrgico. Rev SOBECC. 2014;19(1):3-10. doi: https://doi.org/10.4322/sobecc.2014.003 https://doi.org/10.4322/sobecc.2014.003... Brazil 2014	Descriptive, qualitative/VI	Standardization of processes	Lower costs Easier workflow Quality improvement
Article2020. Macedo JM, Kano JÁ, Braga EM, Garcia MA, Caldeira SM. Cancelamento de cirurgias em um hospital universitário: causas e tempo de espera para novo procedimento. Rev SOBECC. 2013 [cited 2019 Mar 2];18(1):26-34. Available from: http://hdl.handle.net/11449/140728 http://hdl.handle.net/11449/140728... Brazil 2013	Descriptive, quantitative/VI	Absenteeism/client refusal	Cancellation of surgeries
		Emergency surgeries
		Client's clinical conditions
		Failure in the work process
		Lack of structural conditions
		Lack of human resources
Article2121. Bohomol E, Tartali JA. Adverse effects in surgical patients: knowledge of the nursing professionals. Acta Paul Enferm. 2013;26(4):376-81. doi: https://doi.org/10.1590/S0103- 21002013000400012 https://doi.org/10.1590/S0103- 210020130... Brazil 2013	Descriptive, quantitative/VI	Need to warn the medical staff about risk to client’s safety	Retaliation to the nursing team
	Descriptive, quantitative/VI	Low level of autonomy of the nursing leader in the operating room	Retaliation to the nursing team
Article2222. Souza NVDO, Mauricio VC, Marques LG, Mello CV, Leite GFP. Determinantes para suspensões cirúrgicas em um hospital universitário. Rev Min Enferm. 2010 [cited 2019 Feb 24];14(1):82-7. Available from: http://www.reme.org.br/artigo/detalhes/91 http://www.reme.org.br/artigo/detalhes/9... Brazil 2010	Descriptive, quantitative/VI	Absenteeism/client’s refusal	Cancellation of surgeries
		Emergency surgeries
		Client's clinical conditions
		Failure in the work process
		Lack of structural conditions
		Lack of human resources
Article2323. Silva DC, Alvim NAT. Ambiente do centro cirúrgico e os elementos que o integram: implicações para os cuidados de enfermagem. Rev Bras Enferm. 2010;63(3):427-34. doi: https://doi.org/10.1590/S0034-71672010000300013 https://doi.org/10.1590/S0034-7167201000... Brazil 2010	Descriptive, qualitative/VI	Lack of equipment and materials	Decreased functional capacity of the operating room
		Operating room layout	Optimization of the workflow or physical and psychological exhaustion of the nursing team
		Work overload	Damage to interpersonal relationships
Article2424. Hemingway M, Freehan M, Morrissey L. Expanding the role of nonclinical personnel in the OR. AORN J. 2010;91(6):753-61. doi: https://doi.org/10.1016/j.aorn.2009.11.067 https://doi.org/10.1016/j.aorn.2009.11.0... USA 2010	Descriptive pilot- project/VI	Creation of the equipment technician function	Increased time spent in nursing care for the client and increased job satisfaction
	Descriptive pilot- project/VI	Nursing time spent on non-clinical tasks	Creation of the equipment technician function
Article2525. Nepote MHA, Monteiro IU, Hardy E. Association between operational indexes and the utilization rate of a general surgery center. Rev Latino-Am Enfermagem. 2009;17(4):529- 34. doi: https://doi.org/10.1590/S0104-11692009000400015 https://doi.org/10.1590/S0104-1169200900... Brazil 2009	Descriptive, quantitative/VI	Delayed surgeries	Loss of operational capacity (resistance index)
		Cancellation of surgeries	Increased resistance index
		Possibility of relocation of the operating room	Gain in operational capacity (optimization index)
		Adequate time spent in cleaning	Gain in operational capacity (optimization index)
		High occupancy rate	Excessive use of operational capacity
		Surgery exceeds the scheduled time, even when it starts on time	Excessive use of operational capacity
Article44. Grittem L, Meier MJ, Peres AM. Sistematization of perioperative care - a qualitative research. Online Braz J Nurs. 2009;8(3) doi: https://doi.org/10.5935/1676- 4285.20092588 https://doi.org/10.5935/1676- 4285.20092... Brazil 2009	Descriptive, qualitative/VI	Organizational structure	Difficulty in making decision
		Lack of human resources	Reduction of direct care to the client, which is delegated to other members of the nursing staff
		Nursing time spent on non-clinical tasks
		Use of instruments for documentation of nursing care	Guidance on the nursing practice

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[1] Corresponding author:
Ana Luzia Rodrigues E-mail: analuzia64@hotmail.com