Journal of Pediatric Surgical Nursing

Simulation is an innovative teaching tool that is widely used to improve nursing practice. The recent COVID-19 pandemic has revealed new areas of learning for nurses who care for patients in acute healthcare settings. Particularly, the COVID-19-positive patient who experiences a medical emergency, such as a code blue, needs nurses who are skilled in safely delivering lifesaving interventions. This article provides a review of the literature on the use of simulation to improve nurses' response to a code blue emergency with patients with COVID-19. This review includes literature on using simulation to enhance donning and doffing of personal protective equipment. No previous literature discussed conducting a code blue rescue with a patient who has COVID-19. On the basis of the literature reviewed, simulation should be considered as a tool to improve code blue outcomes, confidence of nurse responders, and compliance in proper donning and doffing of personal protective equipment. This article offers implications for further research on the use of simulation to advance knowledge about best practices for nurse response to COVID-19 code blue.

The provisions of healthcare have significantly changed globally as a result of the impact of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Consequently, SARS-CoV-2 has required hospitals to create institution-specific preoperative screening protocols to minimize nosocomial transmission. Nursing leadership at our institution has served an important role in the evolving screening process. Over 260,000 people have been infected with SARS-CoV-2 within Harris County, significantly impacting healthcare systems within the greater Houston area. Institutional surgical screening protocols have thus been designed to improve patient and provider safety while delivering optimal care in accordance with our institution's guidelines and the Centers for Disease Control and Prevention recommendations. Implementation of screening protocols has helped limit transmission of SARS-CoV-2 infection while maintaining high standards of patient care. Through this experience, perioperative nursing personnel have effectively helped design and implement surgical screening protocols while also safely and properly screening patients. In addition, nurses have shown flexibility in response to the evolving nature of the coronavirus disease 2019 pandemic.

The Pre-Surgical Testing program at Cohen Children's Medical Center launched in 2012. We evaluate approximately 7,000 patients per year who are scheduled for outpatient and inpatient surgeries from all pediatric surgical services. The Pre-Surgical Testing program providers are pediatric and family nurse practitioners (NPs). In 2017, the NP role expanded into the inpatient setting. We started to evaluate patients scheduled for emergency procedures, sedated radiology studies, and invasive procedures. We identified high-risk patients, which provided anesthesiologists with the critical information they needed to deliver safe patient care. In 2018, the NPs further expanded into the ambulatory setting. Our role includes preoperative orders, managing postoperative pain, entering discharge medications, and providing continuing education to nursing staff. From February 2018 to August 2018, first-case start times have improved by 20%. The combination of clinical knowledge and experience makes NPs uniquely qualified to identify high-risk patients scheduled for surgery. Other institutions may consider NPs in their postoperative areas to improve OR start times and, more generally, patient safety.

Circulating nurses are important members of surgical teams. They need to use nontechnical skills to work safely. This study aims to review the existing observational tools for the assessment of circulating nurses' nontechnical skills. Electronic resources, including Web of Sciences, PubMed, Scopus, ProQuest, CINAHL, Embase, and Google Scholar, were searched, including studies using tools for observational assessment of nontechnical skills in surgery published up to September 2019. The search process relied on the following keywords: circulating/scout/operating room nurse, observational, assessment tools, operating room nontechnical skills, task management, teamwork, communication, situational awareness, leadership, and decision making. The data were pooled from 30 eligible studies using tools for assessment of nontechnical skills in surgeries. Eight tools were found to assess nontechnical skills for the whole surgical team or individuals, including circulating nurses. Although general behaviors for all surgical team members within the tools have been recognized, there is no specific observational tool for the assessment of circulating nurses' nontechnical skills.