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This systematic review revealed that there remains no evidence to indicate whether removing nail polish and finger rings affects the rate of SSIs after surgery. Given that there are no new studies on this topic, there is insufficient evidence to determine whether wearing finger rings or nail polish affects the number of bacteria on the skin after surgical hand scrubbing.

Case management is a model of care delivery that integrates patient and provider satisfaction and consideration of cost factors and provides a method of managing individuals' holistic health concerns. Using the case management approach, nurses can optimize client self-care, decrease fragmentation of care, provide quality care across a continuum, enhance clients' quality of life, decrease length of hospitalization, increase client and staff satisfaction, and promote cost-effective use of scarce resources. Case management offers nurses an opportunity to demonstrate their roles in multidisciplinary health care teams. Case management is relevant in ambulatory surgery settings and in the perioperative care of complex surgical patients.

Most patients consider breast reconstruction an essential part of total breast cancer management. In the wake of the silicone-gel implant controversy, more women are considering breast reconstruction using their own tissue. Since 1982, the transverse rectus abdominis myocutaneous (TRAM) flap has become a well-established and popular method of reconstruction. For many women, TRAM flap reconstruction is the surgery of choice following mastectomy. It offers victims of breast cancer the potential for soft, natural-appearing breast mounds without the risks associated with other types of flaps or manufactured implants. A description of autogenous tissue grafting using the TRAM flap for breast reconstruction is provided with associated perioperative nursing care guidelines and potential complications.

Changes in health care on the national level are affecting perioperative nursing drastically. Perioperative nursing needs innovative approaches to guide the delivery of nursing care for patients whose operative procedures are performed outside traditional institutions. Managed care and case management are gaining in importance as more surgical procedures are performed in the outpatient arena. New minimally invasive techniques call for new models of delivering professional nursing care. Any model that is developed must ensure that professional perioperative nursing is rewarded, quality patient care provided, and surgical procedure expenses reimbursed.

The CNOR certification is a voluntary commitment that individual perioperative nurses make after considering financial, professional, and personal issues. The results of this survey indicate that CNOR certification is sought to fulfill personal and professional goals. A vital component in the delivery of quality perioperative patient care is the individual nurse. This is true whether or not the perioperative nurse is certified. One question is the value of the CNOR process in the validation of nurses for the delivery of perioperative patient care. It is easy to assume that if knowledge is present, the knowledge will be applied. Assumptions, however, can be misleading. These findings suggest that several nursing traits interact to promote quality perioperative patient care delivery, and CNOR certification is only one of those traits. Claims of CNOR outcomes should be based on documented support rather than assumption and speculation. Further investigation on a much larger and more inclusive scale is needed before suggesting specific changes to the present certification process. This project substantiates the process and the feasibility of conducting future studies. Using a modification of this survey tool in future studies would provide support to the reliability of these findings. This investigation shows that CNOR certification is an important topic to perioperative nursing. With current NCB:PNI proposals and other national considerations, CNOR certification will continue to be an important issue.

Changes are still occurring as we continue to refine the tool. We have now determined that not all OR nurses need to learn to use the tool. The head nurse or assistant head nurse can do it quickly. We are continuing to gather data and hope to have input from other hospitals interested in testing the tool.