1. Perioperative Nursing in the Deployed Environment Welcome to Today’s Webinar Dial in for audio: (866) 740-1260

2. Perioperative Nursing in the Deployed Environment Please be advised that today’s session is being recorded  There is a participant panel that you will see to the left of the PowerPoint slide presentation. If you do not want to see the participant panel, click the “Full Screen” button.  Please type all questions in the Chat at the bottom of the participant panel and click “Send.” The speaker(s) will stop and ask for questions during the webinar session. Any questions that are not addressed in today’s webinar will be answered by the speaker and e- mailed to today’s participants.  Handouts for this presentation were included in the meeting confirmation email you received, please refer to this should you not have them. The handouts and recording link will be emailed to all participants registered for the live event within 48 hours of the presentation.

3. Major Boyle is a nationally certified operating room nurse with over fifteen years of experience. He has a strong background in cardiovascular/thoracic perioperative nursing and has extensive experience in twelve other specialties. He has been a nurse manager of surgical services, an informatics officer, flight nurse, and has deployed in support of Operation Iraqi Freedom and Operation Enduring Freedom. Major Boyle is currently a graduate nursing student at the Uniformed Services University of the Health Sciences in Bethesda, MD, and pursuing a Master’s degree in Adult-Gerontology Clinical Nurse Specialist (AG-CNS). Maj Patrick Boyle

4. Disclosure Information Speaker: Maj Patrick Boyle Discloses No Conflict Accreditation Statement AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. AORN IS PLEASED TO PROVIDE THIS WEBINAR ON THIS IMPORTANT TOPIC. HOWEVER, THE VIEWS EXPRESSED IN THIS WEBINAR ARE THOSE OF THE PRESENTERS AND DO NOT NECESSARILY REPRESENT THE VIEWS OF, AND SHOULD NOT BE ATTRIBUTED TO AORN. Planning Committee: Ellice Mellinger, MS, BSN, RN, CNOR Perioperative Education Specialist, AORN Discloses No Conflict AORN’s policy is that the subject matter experts for this product must disclose any financial relationship in a company providing grant funds and/or a company whose product(s) may be discussed or used during the educational activity. Financial disclosure will include the name of the company and/or product and the type of financial relationship, and includes relationships that are in place at the time of the activity or were in place in the 12 months preceding the activity. Disclosures for this activity are indicated according to the following numeric categories: 1. Consultant/Speaker’s Bureau 2. Employee 3. Stockholder 4. Product Designer 5. Grant/Research Support 6. Other relationship (specify) 7. No conflict of interest Successful completion of this educational activity includes attendance at 90% of the webinar and completion of the evaluation form. AORN IS PLEASED TO PROVIDE THIS WEBINAR ON THIS IMPORTANT TOPIC. HOWEVER, THE VIEWS EXPRESSED IN THIS WEBINAR ARE THOSE OF THE PRESENTERS AND DO NOT NECESSARILY REPRESENT THE VIEWS OF, AND SHOULD NOT BE ATTRIBUTED TO AORN.

5. Describe the overall challenges faced by a military perioperative nurse in the deployed setting Discuss ways in which military perioperative nurses overcome challenges in the deployed environment Describe how challenges faced by a military perioperative nurse in the deployed setting relate to those that may be experienced by civilian nurses in natural disasters Objectives

6. June 9, 2015 Maj Patrick Boyle

7. The views and opinions expressed in this presentation are those of the presenter and do not reflect the views or opinions of the United States Government, Department of Defense, United States Air Force, or the Uniformed Services University of the Health Sciences. Disclaimer

8. Describe the overall challenges faced by a military perioperative nurse in the deployed setting – General environment of the deployed setting – Facilities – Overall logistics of performing surgical procedures (supply, patient transport, etc.) – Work hours Overall Challenges

9. Geographical environment – Ranges from hot and dusty, to cold and snowy, to everything in-between The dusty environment works its way inside the facility – A thin film of fine particulate dust covers EVERYTHING – Makes for difficult clean environment Threat environment – Potential threat of hostilities usually exists – Mission must carry on despite external factors General Environment of the Deployed Setting

10. The facilities vary depending upon location – Typically, some form of portable modular shelter is constructed (tent, conex, etc.) Generally lacking in the luxuries one might find at home Some locations may have hardened facilities – Does not necessarily equate to “better” Facilities

11. The logistics of performing surgical procedures is best summed up by the phrase “Adapt and overcome” Supplies are managed similar to a domestic setting Equipment availability/capability Logistics of Performing Surgical Procedures

12. Transporting patients – To facility – Intra-facility Once in the OR, it’s almost “business as usual” – Alarm conditions – May have to multitask beyond traditional circulator duties Logistics of Performing Surgical Procedures (cont.)

13. Work hours are long… – No paid time off, no holidays or vacations Shift work, plus call Based primarily on number of staff and operations tempo “Semper Gumby” Work Hours

14. Discuss ways in which military perioperative nurses overcome challenges in the deployed environment – Methods for overcoming challenges related to the environment – Overcoming logistical issues – Managing work hours – Facility utilization Overcoming Challenges

15. For personnel: stay hydrated, good nutrition, sleep and exercise Resiliency is key: positive thinking and camaraderie go a long way For the OR: cover as much as you can, keep the areas as clean as possible Be creative and innovative in adapting to the environment while maintaining the OR as close to domestic standards as possible Overcoming Challenges Related to the Environment

16. Work with what you have, and manage supplies and equipment Ordering supplies and equipment is a potential issue (can’t just get something from another hospital downtown) Become friends with the “loggies” Overcoming Logistical Issues

17. Give down time whenever possible Don’t overwork your staff… – But remember that there is a mission to accomplish Work hard and play hard Try to be fair/equitable in scheduling Managing Work Hours

18. Work and storage space may be limited – Find creative ways to make the best of available space Make friends with other departments (ICU, ward, Lab, radiology, supply, etc.) Be familiar with the capabilities of the facility/prepare for contingencies – What if the power goes out? What about back-up O 2 ? What if we get attacked? Facility Utilization

19. Describe how challenges faced by a military perioperative nurse in the deployed setting relate to those that may be experienced by civilian nurses in natural disasters – Similarities between perioperative care in the deployed setting and during natural disasters – Utilizing perioperative methods from the deployed environment for a natural disaster scenario Similarity of Challenges

20. You may be put into a “mass cal” situation that overwhelms your resources and personnel This is not a normal situation for anyone – Make sure there are “hotwashes” and debrief time Schedules are fluid based on ops tempo Similarities Between Deployed and Natural Disaster Settings

21. Have a scenario plan in-place and train to it if possible Be prepared to work outside of your lane (to some extent) Manage resources Learn to adapt and overcome limitations Teamwork – Support one another – you’re all in this together Utilizing Perioperative Methods from the Deployed Environment

22. Questions and Answers Thank you for joining us today!

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25. Agazio, J. (2010). Army nursing practice challenges in humanitarian and wartime missions. International Journal of Nursing Practice, 16(2), 166-175. doi:10.1111/j.1440- 172X.2010.01826.x Blaz, D., Woodson, J., & Sheehy, S. (2013). The emerging role of combat Nursing: The ultimate emergency nursing challenge. Journal Of Emergency Nursing, 39(6), 602- 609. doi:10.1016/j.jen.2013.09.001 References