AMATEURS IN RESEARCH Mabel Crawford, ORS

In 1952, a group of operating room nurses with a gleam of hope in their eyes struggled to establish the AORN of Los Angeles. Even at that early stage, one of the nurses sug

Mabel Crawford is a graduate of the Bishop Johnson College of Nursing in Los Angeles, California. For a period of 29 years she has been employed as stafi nurse, head nurse, and supervisor at The Hospital of the Good Samaritan, Los Angeles, California. She has been associated with Immaculate Heart Col- lege, Los Angeles, was the first president of AORN of Los Angeles, and the chairman of the chapter’s Research Committee since its inception. In all, a total of sixteen Los Angeles chapter members have worked on the Committee for varying periods of time. Miss Crawford wishes to express her great appreciation to each of these members for their untiring efiorts. As this issue goes to press, she reports, the Research Committee is deep in plans for a new survey.

gested that a special committee be established to record the history of the local chapter, and to conduct pertinent studies of operating room practices in the area. This suggestion was adopted, and became a part of the chapter’s by-laws.

During the early years, this special com- mittee restricted its efforts to keeping a his- torical record. It was not until 1958 that the local Board of Directors requested that the “Research Committee” be activated accord- ing to the original intent. A chairman and five members were appointed to carry out the work of the committee.

At the first meeting of the committee the following proposals were devised, to be sub- mitted to the Board for approval:

1) That the committee consist of a mini- mum of six active members;

2) That the committee function under the title of Research Committee, and without concern for the history of the AORN of Los Angeles;

July-Aug 1966 67

3) That the aims and purposes of the com- mittee be: a) to collect information of pro- fessional interest for the members of the AORN of Los Angeles; b ) to examine and correlate this information into reports; and c) to establish methods by which i t would be made available.

We had no experience or training in this area, and in view of what we now know, the use of the term “research” was perhaps a misnomer. The committee’s work has been more in the nature of surveys than of formal research. Nonetheless, the work has broad- ened our horizons, added some measure of scholarship skills to our armamentarium, and given us the basic reward we sought- the answers to various questions which our members have raised throughout the years for use in their daily function as OR nurses.

OUR INITIAL EFFORT The real work of the committee began in

May, 1958. The greatest interest at that time seemed to be in preoperative skin shaves and skin preparation. The members agreed to make up questionnaires concerning these topics, and to send them to all operating room supervisors at the hospitals in their area. This was mistake number one! We had an excellent return on the questionnaires- but it was almost impossible to tally them since each member had made up different questions! Even so, a report was given at a chapter meeting in November, 1958.

The inexperience of our committee had been laid bare. Nothing daunted, we asked for concrete suggestions from the member- ship to use as a basis for future surveys to be conducted in the form of questionnaires. Our first attempt made us realize that there is more to research than just being interested gnd willing. We consulted articles, mono- graphs and books on this subject of doing research. Back in those days, we would have been very grateful for Lucille E. Notter’s AORN Journal artic1e.l

THE 1959 SURVEY At a meeting held the following March

(1959), the aims of the committee were re- viewed, along with a discussion of our over- all goals and plans for the future. The topics suggested by the chapter members were dis- cussed and the following was planned:

1) That a series of four questionnaires be formulated to include these topics:

A ) Techniques for preoperative shave and skin preparation.

B) Sterilization and processing of anes- thesia supplies, gloves and sutures.

c) Packaging and resterilization of linens, miscellaneous supplies and instru- ments.

D ) Contaminated technique utilized in the operating room.

2) That each member of the committee send to the chairman questions for each questionnaire. The chairman would organize the material.

3) That the operating room supervisor in 50 hospitals in the Los Angeles area be sent the questionnaires with a request that they be completed and retuined.

The committee followed through with this plan. Questions were sent to the chairman, who assembled and organized them. A rough draft of each questionnaire was mailed to each member for correction, additions or re- vision. Use of the telephone helped speed the process. The method worked so well that only slight changes have been necessary for the questionnaires which have been form- ulated more recently.

It took six months to circulate the 1959 series and to tabulate the results on all four of the questionnaires. Tallies were made of the responses. They stated the number of hospitals using a specific technique, pro- cedure, or type of supplies. No attempt was made by the committee to interpret the find- ings. Copies of the tables were sent to all supervisors who answered the questionnaire. They were and are available to any operating

68 AORN Journal

room nurse within the Los Angeles area, upon request. This continued to be true throughout all of the later surveys as well.

We started by sending out 50 copies of Questionnaire A concerning pre-op shave and skin preparation. Of these, 34 were re- turned. This represented a 68 per cent re- turn which encouraged us to send out Ques- tionnaire B: restricting it to only those who had answered the earlier one, 34 in all. This netted us 33 responses, or 97 per cent which we now realize is much more than can nor. mally be hoped for. We thought it was only our due! Hastening on with the series, we sent Questionnaire C on packaging and re- sterilization to the 33 returnees. Here we again received handsome returns-32, or 94 per cent. Questionnaire D was sent to those 32 who had remained with us from the origi- nal 50 but for some reason, only 15 were returned to us. This represented a 47 per cent return.

THE 1964 SURVEY In January, 1964, the committee dmit l~d

that enough time had elapsed s i n e the previous survey to make a new survey worth- while. After some discussion, the consensus was to base a new series of questionnaires on those used in 1959, with considerable revi- sion, and to add a fifth topic, that of dis- posable items. The principal objective of the new survey was to determine the amount of change which had transpired.

To make such comparison it was necessary to use the same list of hospitals which had been used in 1959, and this was done, even though we realized that in some of them the operating room supervisors had been changed.

The proportion of questionnaires returned on the 1964 survey were not very different from those of 1959. We considered this very gratifying, and went ahead with the process of tabulating. Now we were able to compare how many had said “yes” to a question in

TABLE I

PRACTICES OF LINEN PROCESSING RE- PORTED BY 34 OR UNITS IN 1959 AND 33 OR UNITS IN 1964 IN THE LOS ANGELES

AREA* No. of No. of

“yesses” “yesses” 1959 1964

Laundered in: Hospital laundry Commercial laundry

Folded & packs made in: Surgery Central Supply Laundry Separate linen room

once before laundering Wrappers are used more than

Do you use rings on lap sponges

Do YOU rotate sterile supplies

When: Every day Every week Every two weeks Every month

HO“ often are linen-wrapped items resterilized: Every two weeks Three weeks Every month Two months Six months Don’t

‘$ One hospital closed in 1960.

21 21 7 10

17 13 7 11 2 4 1 4

8 4

18 15

27 29

24 23 1 3 0 1 1 1

6 2 1 0 12 20 0 2 0 1 0 2

1959, and how many had said “yes” in 1964. We now realize that it would have been sounder for us to compare the proportion of “yes” responses from each survey, rather than the numbers of “yes” responses. How- ever, we did the latter, and because the num- bers of returns from each survey were fairly close, we feel that the figures do give us sub- stantial information. Results were thus tabu- lated and copies sent to all participating hospitals by August, 1964.

Our complete file of these surveys, with copies of covering letters sent to hospitals and such relevant material, weighs close to a pound so the reader will understand why we are presenting below only a few sample com- parisons which seem to indicate trends in the Los Angeles area in the five years between

July-Aug 1966 69

TABLE II

PRACTICES OF INSTRUMENT PROCESSING REPORTED BY 34 OR UNITS IN 1959 AND 33 OR UNITS IN 1964 IN THE LOS ANGELES

AREA*

No. of No. of ‘*yesses” “yesses”

1959 1964

Are your G.I., G.B. and GYN instruments: 1) Kept sterile 17 2) Sterilized at time

of surgery 12

Instruments cleaned after surgery by: 1) Instrument washer 9 2) Hand 22

* One hospital closed in 1960.

TABLE 111

17

7

18 14

CONTAMINATED TECHNIQUE REPORTED BY 34 OR UNITS IN 1959 AND 33 OR UNITS IN

1964 IN THE LOS ANGELES AREA* No.of N0.0f

“yesses” 46yessesv1 1959 1 a64

Who determines that case is septic: Operating surgeon 12 12 OR supervisor 10 7 Hospital policy 3 5 Pathology department 1 0

Septic cases scheduled last 7 8

Standard technique for all cases: 12 12 Vary with degree of sepsis 2 2 Vary with septic organism 4 3 Room closed for time interval 1 2

Record kept of all septic cases: 5 7 On file in record room 4 6 ORS receives

a COPY 4 2

Nursing office receives a COPY 4 5

unit is: Part of routine OR setup 8 1 Taken into OR when case

15 completed 6 6 Left outside OR entirely 1 4

During case, cleaning

Cleaning unit for unknown

Brought in when case is

Ready but not taken

septic case:

found septic 8 1

into OR 7 10

* One hospital closed in 1960.

the 1959 and 1 9 a studies. The comparisons given here relate to the questions concern- ing contaminated technique, processing of linen, and processing of instruments. All

the data are based on 34 operating room respondees to the 1959 questionnaires, and 33 respondees to the 1% questionnaires. The respondees did not necessarily answer each item on the questionnaire, which ac- counts for any discrepancies which appear in the tables given here.

THE 1965 SURVEY As a result of the comments received from

members at the meetings and through the mail, the committee decided to carry on with another series of questionnaires in 1%5. Thinking we could get more nurses interested as working members of this committee, we agreed upon the following:

1) Each member was to choose the topic of her questionnaire, with the committee’s approval.

2 ) Each member was to be chairman for her chosen topic, and she was to select her subcommittee.

3) The hospital list was to be revised. The questionnaires for 1965 included new

areas of study, on personnel in the operat- ing room, and pre- and postoperative man- agement of the patient. It was also decided to repeat the survey on disposable items.

Perhaps the greatest interest and changes appeared in relation to disposable items. The avaiIability of new products increased greatly in one year. In 1964 we had 13 items on our questionnaire, whereas in 1965, our list increased to 36 items. A month later we probably could have added another ten items. At least, one could determine from the tallies which items seemed to be most frequently used in OR nursing. Also, it provided a list of disposable items available for use in the operating room, as known by the committee members.

CONCLUSION By notes received from the participating

supervisors, the results of our various studies have served to indicate ideas and changes in

70 AORN Journal

OR procedures, at least in the participating departments. It is interesting and helpful to know to some degree how one’s own hospital compares with others. The results also pro- vide a basis for discussing possible changes of present methods and procedures, especially when the surveys indicate that the majority of the hospitals are using different equip- ment and procedures from one’s own. Each committee member has also been helped in

positive return on any project undertaken by a committee depends upon persistence, origi- nality, intuition, interest of the local mem- bers¶ time, planning and knowledge in one’s own field of activity. It also depends on the participants, those operating room super- visors who took time from their busy work schedules to answer our questionnaires. We want to thank them again-without their as- sistance we would not have had this valuable

solving some of her own problems, as well as providing information for other OR supervisors and personnel.

Looking back at our inexperience and lack of knowledge about this highly technical field of research, we wonder at our courage in starting on such a venture and to expect to get results. We found support and en- couragement in the following statement: “Re- search is a high-hat word that scares a lot of people. It needn’t . . . it is nothing but a state of mind . . . a friendly, welcoming at- titude toward change. It is the problem- solving mind as contrasted with the let-well- enough-alone mind. It is the [‘tomorrow’] mind, instead of the ‘yesterday’ mind.”2 The

experience.

REFERENCES 1. Notter, Lucille E., “Research Versus Routine in the Operating Room,” AORN Journal, Vol. 3 , #6, November-December, 1965. 2. Good, Carter V., Introduction to Educational Research, Appleton-Century-Crofts, New York, 1963. Additional material: Abdellah, Fay G. and Levine, Eugene, “Directions for Research Nursing,” Am. J . Nursing., Vol. 66, #1, January, 1966. Boyd, Thomas Alvin, Professional Amateur: The Biography of Charles F. Kettering, E. P. Dutton, New York, 1957. Good, Carter V., and Scates, Douglas E., Methods of Research, Appleton-Century-Crofts, New York, 1954. Hayes, Samuel P., Jr., Measuring ?he Results of De- velopment Projects, UNESCO (Printed in France), 1959. Shannon, J. R., “Percentages of Returns of Ques- tionnaires on Reputable Educational Research,” Journal of Educational Research. October, 1948.

EDITOR‘S NOTE: Because we thought that our interest, challenging us to new learnings, these self-styled ccamateurs” might like to and acquainting us with resources for help. have an expert’s appraisal for their accom- In conducting a second survey, the Commit- plishments, we asked Dr. Myrtle Brown, tee was able to improve its methods of study. author of the article which precedes this Comparable data, collected at time intervals, one, fur her commenh. Her reply follows: reveal trends which with varying degrees of

“This Los Angeles committee is to be dependability can be projected into the highly commended for surveying local cur- future. Publication of this initial eflort rem practice. Such descriptive studies serve should encourage other nurse practitioners as an introduction to research-stimulating to undertake studies.”

71