Congress General Sessions

Attendees of the 60th Congress General

sessions heard inspirational, practical, and

thought-provoking presentations. Featured

speakers at these sessions promoted collaboration,

a culture of transparency in the OR, the power of

positive thinking, improved approaches for deci-

sion making, emotional intelligence, and humor as

a shortcut to happiness. Following are brief ac-

counts of this year’s sessions.

A panelist participates in a root cause analysis anddebriefing to identify missed opportunities to preventa postoperative surgical site infection in a fictionalpatient.

USING SIMULATION TO DEMONSTRATEPERIOPERATIVE COLLABORATION

To exemplify the effect of collaboration between

perioperative personnel and the infection pre-

ventionist, Paula R. Graling, DNP, RN, CNOR,

CNS, past president of AORN and current president

of the AORN Foundation, led a panel of eight

health care professionals in a simulation about

a fictional patient who developed a postoperative

surgical site infection (SSI). During the Jerry G.

Peers Lectureship, “Simulation: Collaboration

Between the Perioperative RN and Infection Pre-

ventionist,” the panel performed a root cause

analysis and debriefing to identify missed oppor-

tunities to prevent an SSI in the fictional patient.

The simulation began in a clinic examination

room when the patient presented with a superficial

wound infection after hernia surgery. A series

of videotaped vignettes portrayed the multidisci-

plinary team members reviewing the care provided

to the patient during her hospitalization. After

viewing each vignette, attendees were asked a

series of questions and answered them by a show

of hands. Attendees helped the panel identify mul-

tiple problems that might have caused the patient’s

SSI, including

n the patient’s failure to take the two prescribed

preoperative antiseptic showers;

n hair removal using a razor in the OR;

n failure to cleanse the hub of the IV line before

injecting the antibiotic;

640 j AORN Journal � June 2013 Vol 97 No 6

n failure of the surgeon and anesthesia profes-

sional to adequately communicate whether

antibiotic redosing should occur and, if so,

when; and

n failure of scrubbed personnel to adhere to the

basics of aseptic technique.

Dr Graling asked attendees to come to the mi-

crophone to report on successes and failures at their

facilities. From this interactive discussion, at-

tendees determined that everyone should at least

consider the following steps:

n Implement updated presurgical skin prepara-

tion for all patients whether surgery is per-

formed in the hospital or an ambulatory setting.

n Remember to check the sterility of the instru-

ments every time.

http://dx.doi.org/10.1016/j.aorn.2013.04.015

� AORN Inc, 2013

Dr Marty Makary stresses the need for culturechange to improve patient safety.

CONGRESS GENERAL SESSIONS www.aornjournal.org

n Use forced-air warming for 30 minutes in the

preoperative area.

n Avoid dual standards of care between inpatient

and ambulatory settings.

n Repeat antibiotic dosing based on the percent-

age of blood loss so that the level of antibiotics

in the blood remains consistent.

n Have an evidence-based, multidisciplinary con-

versation about bringing bags and personal items

into the OR.

n Implement back-to-best practices to ensure staff

member competency.

n Institute multidisciplinary follow-up of all re-

ported adverse incidents.

n Ensure that the patient’s glucose levels are

monitored and controlled.

n Make the infection preventionist an integral

member of the surgical team.

The concluding sentiment and discussion fo-

cused on perioperative nurses as the patient’s last

line of defense against acquiring an SSI and the

importance of collaboration between perioperative

team members and the facility infection preventionist

to achieve best practices and thus prevent SSIs in

vulnerable perioperative populations.

REBECCA HOLMMSN, RN, CNOR

CLINICAL EDITOR

A CALL FOR CULTURE CHANGE

At the session “The New Accountability Move-

ment: How Transparency Is Changing the OR,”

Marty Makary, MD, MPH, discussed the state of

patient safety in the United States. Little progress

has been made in patient safety in the past 10 years

despite efforts to promote it, according to Dr

Makary, a surgeon at Johns Hopkins, Baltimore,

Maryland, and New York Times bestselling author

of Unaccountable, a book on how teamwork and

transparency can save American health care. He

shared the story of St Vincent’s Hospital in New

York City, a once-prospering hospital that went

bankrupt and closed after 160 years. The hospital’s

decline was caused by executives who had become

dangerously out of touch with the frontline pro-

viders, a trend Dr Makary indicated is one of the

greatest threats to American medicine. He extended

his argument by saying that this is a dangerous

trend in society in general, not just in health care,

and gave several examples in the financial industry.

To solve the nation’s current problems in health

care, the culture of medicine needs to change.

Changing the culture of medicine involves lifting

the veil of anonymity and restoring dignity and

value in the OR. That begins with executives

reaching out to frontline providers to understand

what providers need so that they can do their jobs

better. Dr Makary cited Steve Jobs, cofounder and

former CEO of Apple, Inc, as a “genius manager”

who leveled the hierarchy by eating in the company

cafeteria and holding conversations with new em-

ployees. Dr Makary declared that good manage-

ment is not something that needs to be invented

but rather “a value in society we need to restore.”

He described how Apple store employees are al-

ways eager to help customers, despite not having

commission-based roles, because of the successful

workplace culture that encourages workers to take

pride in their organization.

Dr Makary noted that a corporate culture goes

“sour” when employees are concerned only about

AORN Journal j 641

June 2013 Vol 97 No 6 CONGRESS GENERAL SESSIONS

“doing their job.” Culture defines how employees

do things, including whether a surgeon pursues

a minimally invasive surgery or a maximum inva-

sive surgery. He then highlighted results from

a questionnaire on safety attitudes that showed that

only 18% to 20% of hospital personnel surveyed

would go to their own facility for medical care. In

a slide comparison, he showed a direct correlation

between postoperative morbidity rates and the per-

centage of medical personnel who would feel safe as

a patient in their own facility.

As a lead author for the original Johns Hopkins

surgical checklist and as a contributor to the World

Health Organization Surgical Safety Checklist, Dr

Makary stressed the importance of the preoperative

checklist and, particularly, knowing the names of

the team members who work on one’s shift. Among

a survey of perioperative professionals, physicians

ranked the lowest among nurses, anesthetists, and

others for knowing the names of colleagues on

their shift.

The culture of “speaking up,” which encourages

personnel to voice their concerns without fear of

retribution, needs to be embraced. Research indi-

cates that perioperative professionals are more

likely to speak up when OR teams use surgical

checklists. A recent study of hospital leaders re-

vealed that 26% believe that nurses’ fear of retri-

bution decreases safety at their hospital. Dr Makary

gave the call to action to restore value and dignity

in the OR by promoting the culture of speaking up,

noting that changing the culture is necessary to

save American health care.

LESLIE KNUDSONCONTENT EDITOR

JR Martinez entertains attendees with humorous andinspiring insights that he gained through his recoveryfrom the severe burns that he sustained in Iraqin 2003.

THE POTENTIAL TO MAKE A DIFFERENCE

At 19 years of age, JR Martinez believed that

joining the army would provide him with educa-

tional opportunities that he could not access as the

only son of a single mother. What it provided

instead was a 34% burn injury and other severe

injuries from driving over a roadside bomb in Iraq

642 j AORN Journal

in 2003. In his talk “Plugging in to Your Potential”

at the AORN Foundation session, Martinez de-

scribed three years of recovery and more than 32

surgeries. He talked to the audience about how

nurses and his mother helped him change from

a young, angry survivor who wondered what he had

done to deserve his severe burn injuries and who

saw his life goals disappearing to someone who

believes that “you can choose where to go; you

need to find a way to be positive, to adapt, and to

overcome whatever comes your way.”

Martinez humorously described his first thoughts

after waking from a medically induced coma and

listening to the physician describe what “the nurse”

would help him do to recover. At his young age, he

said, he tuned out the physician and imagined that

this nurse would be a young gorgeous woman who

would fall madly in love with him while providing

his care. He was clearly disappointed to meet instead

a bearded male nurse named Mike. Martinez told the

audience that he and Mike became close friends, and

he credits Mike with helping in his recovery. In a

less humorous vein, he spoke of what it felt like to

CONGRESS GENERAL SESSIONS www.aornjournal.org

survive the explosion and be trapped in a burning

Humvee. Martinez credits his nurse with helping

him confront his devastating facial burnsdMike

told him that what he would see when he looked in

the mirror was not good, but it would get better,

and he helped Martinez make it through a painful

but necessary recovery. Nurses, he said, “help

make scary and uncomfortable places not so scary.”

After seeing the extent of his injuries, Martinez

fell into a deep depression. He saw his life and his

goals as having been destroyed and lashed out in

anger at his mother when she tried to comfort him.

His mother, whom he affectionately refers to as the

“hand grenade,” told him he had a lot to learn. She

encouraged him to be positive and told him that

a purpose for his life would emerge. She also told

him that whoever was in his life from this point on

would be there because they valued him and would

not be troubled by how he looked. He has come to

believe that everyone has strengths and weaknesses

and that in times of difficulty it is important to

focus on strengths to cope and adapt to changes.

During his recovery, Martinez did find new pur-

pose. Hospital staff members asked him to speak to

other patients with similar difficulties. He learned he

could help people, which made him feel good. After

being asked to speak publicly about his experience

after his discharge, Martinez auditioned for and was

offered a three-month role on All My Children, a soap

opera, and went on to become a contestant on Danc-

ing With the Stars. He has become a motivational

speaker and still enjoys visiting patients to help

them get through difficult experiences. In his parting

words,Martinez cautioned that it is “easy to feel as if

what you’re doing has no purpose or reward.” He

voiced his hope that attendees would “walk away

knowing that what you do is important and that I am

grateful to know that nurses are there.”

Dan Heath discusses important ways to make betterdecisions.

IMPROVING THE DECISION-MAKINGPROCESS

Dan Heath, a senior fellow at Duke University’s

Center for the Advancement of Social Entrepre-

neurship and coauthor with his brother, Chip Heath,

of several motivational books, spoke to Congress

attendees about decision making and how to make

a difficult process easier. At “Decisive: How to

Make Better Choices in Life and Work,” he noted

that decisions are bad more often than they need to

be and that human beings’ most flagrant bad deci-

sions concern money, the people they choose as life

partners, and medical issues. His book Switch: How

to Change Things When Change Is Hard addresses

how decision making can be improved.

Heath told the audience that although common

advice urges people to “trust their gut” or to rely on

analysis, this is rarely successful. Of decisions made

in the work arena, for example, 80% of mergers or

acquisitions create no value and at least half of all

newly hired employees leavewithin the first year. He

suggested that to do better in work or in life, at-

tendees should remember that people are rarely

stumped for answers. The answers arrived at through

intuitionmay be faulty, however, because intuition is

a machine for jumping to conclusions that may or

may not be accurate or helpful. “It is impossible to

know if an intuition about something is trustworthy,”

he said, but intuitions that can be trusted are “those

AORN Journal j 643

June 2013 Vol 97 No 6 CONGRESS GENERAL SESSIONS

that come from long experience or lots of repetition

and those where the individual gets quick feedback

about his or her decision.” As an example, he spoke

of eating at a restaurant and showed the audience

a photo of the red velvet cheesecake he wanted for

dessert. His intuition was that this would be the

perfect end to a perfect meal, but then he noticed that

the calorie count was nearly 2,000; that quick feed-

back enabled him to pass on the dessert.

Heath described a four-part process to improve

decision making with the acronym WRAP: widen

options, reality test, attain distance, prepare to be

wrong. He encouraged attendees to widen their

options rather than to act like teenagers, who often

see only two options and do not have a secure or

mature structure for making decisions. “Only 30%

of teenagers consider more than one option when

making a decision, and sadly, only 29% of orga-

nizations consider more than one alternative ei-

ther,” he said. “The phrase ‘whether or not’ should

set off alarms if you hear it when making a decision,

because it is a narrow way of framing a decision.”

He also recommended that attendees “fall in love

twice”din other words, look for more than one

option, avoid excessive focus, and resist intuitive or

quick decision making. “Ask yourself, ‘Is there

anything else I need to know and what else could

be available?’” he posed. This process helps test

reality, which may be camouflaged by emotion or

pressure to make a decision. Attaining distance

from the decision (eg, asking for time to consider

choices) helps as well. Finally, he suggested that

preparing to be wrong is helpful in that it readies

a person for surprises and keeps options open by

providing the opportunity to create a backup plan.

HELEN STARBUCK PASHLEYMA, RN, CNOR

CLINICAL EDITOR

Dr JP Pawliw-Fry describes emotional intelligenceskills that can improve career and home life.

LEARN EMOTIONAL INTELLIGENCE ANDFIND SUCCESS

Dr JP Pawliw-Fry spotlighted emotional intel-

ligence at the opening keynote session, “What’s

644 j AORN Journal

Going on at Your Hospital?” Using jokes and funny

video clips, Dr Pawliw-Fry stressed two tools for

emotional intelligence that people can learn: mak-

ing oneself vulnerable and building bridges. He

said that although intelligence and technical skill

are important to a certain level to be competent in

a job, emotional intelligence is a bigger predictor of

career success. When listing the traits of the best

nurses they have ever known, most people would

list emotional intelligence, such as staying calm

under pressure, rather than extraordinary intelli-

gence or technical skills. “If you want a star, it’s

not about how smart you are,” Dr Pawliw-Fry said.

People who are not afraid to admit they are

wrong have more success in life. On successful

teams, the leaders are first to admit when they have

made mistakes. “You are a leader of folks,” Dr

Pawliw-Fry said. “People are watching you. What

do you do when you’re under pressure and you

make a mistake?” If leaders admit their own mis-

takes, others team members will do likewise, im-

proving the team overall. “Our challenge is to be

that walking model of a leader,” he added.

CONGRESS GENERAL SESSIONS www.aornjournal.org

Dr Pawliw-Fry also spoke about the emotional

trap of confusing impact with event. Because of

how our brains work, we tend to react emotionally

to an event before we act rationallydwe feel be-

fore we think. For example, a nurse may feel as if

a coworker’s actions were taken to target him or

her. “People don’t do things to us; they do things

for their own reasons,” Dr Pawliw-Fry said. “Be-

fore you throw someone under the bus, make sure

you have enough info.” It is important to allow time

for the emotional part of the brain to calm down,

which can take 15 to 17 minutes, before reacting to

a disruptive event. Another mistake is that we judge

ourselves by our intentions but judge others by the

effects of their actionsdwhat Dr Pawliw-Fry calls

the “understanding gap.”

He described his strategy for connecting to

others as “building a bridge,” shortening the name

of this process to “VVF”: ask questions to give

a voice to the other person’s intentions; make the

other person feel valued; and then, finally, provide

feedback. He recommended that we show others

we value them by saying what we mean, doing

what we say, finishing what we start, and starting

things on time.

“If you build trust in your organization, that’s

the foundation for collaboration,” Dr Pawliw-Fry

said. By cultivating emotional intelligence, nurses

can help build an effective team. He used the ex-

ample of the very successful Chicago Bulls bas-

ketball team from the 1990s; even though most

would agree that the team was lacking in some

areas technically, their emotional intelligence,

especially that of their coach, allowed them to

achieve great success.

Karyn Buxman explains how being amazed andamused is the key to attaining true happiness.

CONGRESS CLOSES ON A HUMOROUSNOTE

Mental health strategies, jokes, and a dance lesson

combined to give attendees a memorable experi-

ence at the closing session, “Amazed and Amused:

How to Survive and Thrive as a Health Care Pro-

fessional.” Karyn Buxman, MSN, RN, CSP, talked

about how stressful the OR environment can be and

recommended humor as a powerful tool to combat

this stress. Referring to airplane safety demonstra-

tions, she said that nurses need to take care of

themselves first before they can help others.

“Humor can be your oxygen mask,” she said.

Humor is an important trait for leaders to have,

according to Buxman, who noted that this trait

does not necessarily have to take the form of

telling jokes or being funny. People who are not

good at making jokes can simply appreciate humor

from other peopledtheir laughter will demonstrate

to others that they have a sense of humor.

Moving away from humor, Buxman taught at-

tendees another method to maintain mental health.

“We are going to teach you how to dance, to have

a shortcut to happiness,” Buxman told attendees.

She proceeded to teach attendees a series of

dance moves, including the “cowboy” and “pony!

(Gangnam style)” to the song “Just Dance” by

Lady Gaga.

Buxman also spoke about feeling “icky.” She

said everyone has icky times and warned that any-

one not currently going through an icky period or

just getting out of one will experience it again. She

AORN Journal j 645

June 2013 Vol 97 No 6 CONGRESS GENERAL SESSIONS

shared her own icky time: a seven-year period

during which one of her sons had an undiagnosed

ailment that caused severe symptoms, including

temporary paralysis. Also in that period, her other

son was diagnosed with a large chest tumor and

her mother was diagnosed with Alzheimer disease.

Fortunately, both of her sons recovered from their

conditions. This period led Buxman to reexamine

her life, and by doing so, she discovered the im-

portance of self-reflection. She said that sometimes

nurses tell her they feel as if they are not getting

anywhere in work or in other stressful situations.

She then asks them what their goals are, and they

frequently say they do not know. Her response is to

ask them, “Then how do you know you’re not

already there?” Self-reflection is important in one’s

646 j AORN Journal

personal life, she said. For example, after Buxman

and her husband divorced, she made a list of ex-

actly what she wanted in a partner before she began

to date again.

One element of humor is what Buxman calls an

“amazed and amused” attitude, which she said

helps her appreciate what happens around her.

She noted that many of the best things in her

life would not have happened had the bad

things not happened. Being amazed and amused

by life allows people to experience true

happiness.

ZAC WIGGYASSOCIATE EDITOR

Correction

May 2013, VOL 97, NO 5, page 556. Due to an

editing error, the “No” and “Yes” headings in Table 2

were listed incorrectly. The table should have

appeared as follows. The Journal regrets the error.

TABLE 2. Comparison of Groups forIncidence of Surgical Site Infection

Surgical site infectionwithin 30 days of surgery

No Yes

Parachoroxylenolprep (n ¼ 71)

71 0

Other prepagents (n¼ 91)

86 5

Note: c2 (1, 162) ¼ 4.025, P ¼ .045.