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use within this review. Implications for practice The review demonstrated that empirical data surrounding perioperative nursing staffing is widely available. Fatigue, perioperative nurse education and nurse-to-patient ratios have a significant impact on the safety of patients undergoing invasive procedures. However, there is a lack of quantitative data surrounding these staffing factors. Keywords: perioperative, staffing, nursing, fatigue, ratio, training Authors Nick Nijkamp MClinNg (Anaesthetic & Recovery Nursing), BNurs(Dist), RN, MACORN Dr Paula Foran PhD, RN, FACORN, FACPAN, MACN Emerging scholar article e-16 Journal of Perioperative Nursing Volume 34 Number 1 Autumn 2021 acorn.org.au Problem identification The provision of safe, quality patient care is central to all health care professionals, including nurses. Nursing care is seen to exemplary levels within the perioperative nursing field; the vulnerability of patients as well as the complex and invasive procedures undertaken make the perioperative nurse a powerful patient advocate1 . Advocacy for safety and quality care is integral to perioperative nursing1 . However, the effects of staffing, staff training and rostering practices can greatly affect the safety of patients2–5 . This integrative review describes some of the effects of these staffing practices in relation to patient safety within the perioperative nursing field. This review found significant literature surrounding nurse satisfaction in relation to staffing, rostering practices and training. However, there is a lack of contemporary Australian literature related to these practices and patient safety. This literature review focused specifically on fatigue, staff training and nurse-to-patient ratios in relation to patient safety within perioperative nursing1 . Each of these components, if managed appropriately, can significantly improve the quality and safety of patient care. Literature search The research question that provided guidance for this review was ‘how does perioperative nurse staffing effect safe patient care?’ An integrative literature search for mixed methods, qualitative and quantitative research was conducted through the use of databases which included CINAHL, JBI, Medline and PubMed. Appropriate inclusion/exclusion criteria and search terms were used. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were followed6 . Figure 1 demonstrates the PRISMA review undertaken. A literature review matrix is included in the supplemental material. Additionally, a manual search of ‘Fatigue’7 and ‘Staffing for safety’8 in the 16th edition of the Australian College of Perioperative Nurses (ACORN), Standards for Perioperative Nursing in Australia3 (the ACORN Standards), was performed, and a relevant textbook was identified9 . This integrative review indicated the contemporary empirical literature and limitations surrounding perioperative nursing staffing and allowed for in-depth review of the literature. Inclusion and exclusion criteria Pertinent inclusion and exclusion criteria were set for the literature review to ensure relevance and applicability of the articles. Relevance was confirmed as all articles were related to perioperative, nursing and staffing factors. Age filters were applied to ensure contemporary literature was used. The search looked for articles published after 2015; however, some older articles (n=3) were included as they provided seminal research and are referenced in contemporary articles. Literature was also selected to provide References identified through database screening CINAHL, JBI, Medline and Pubmed (n=216). Duplicates (n=51). References after duplicates removed (n=165). References screened (n=165). References excluded (n=134). Full-text articles assessed for eligibility (n=31). Full-text articles excluded (n=16). Additional references sourced via manual searches of professional standards and textbooks (n=3). 15 articles included in Integrative Literature Review. 2 Professional Standards included. 1 Text book included (n=18). Figure 1: PRISMA flow diagram of integrative review Journal of Perioperative Nursing Volume 34 Number 1 Autumn 2021 acorn.org.au e-17 appropriate breadth and depth of review.
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