Asian Journal of Medicine and Health

Enhancing Operating Room Nurses’ Clinical and Communication Competence in Perioperative Care within Surgical Context: An Integrative Literature Review

Wed, 08 Jul 2026 00:00:00 +0000

Background: Globally, the complexity of surgical procedures has increased due to changes in the delivery of care. Perioperative care requires competence to promote patient safety and self-care. This includes medical assessment to identify comorbidities, screening to identify risk factors and patient risk assessment. Postoperative care depends on the invasiveness of the procedure and is divided into two phases: (a) the immediate postoperative period, usually after major procedures, when the patient may need to be transferred to critical care or recovery units; and (b) the late postoperative period, when some patients experience physiological and functional decline after surgery. Patient safety issues and communication errors may emerge when operating room nurses are under stress and perform multiple tasks that interfere with cognitive processes. Studies show that errors occur when nurses do not understand their roles or do not feel supported, valued or respected. Therefore, clinical and communication competence is important for establishing a culture of patient safety. Objectives: This integrative literature review synthesizes existing evidence on strategies, interventions and factors that enhance nurses' clinical and communication competence in perioperative care within the surgical context. The review seeks to identify how these competencies contribute to patient safety, teamwork, surgical efficiency and the quality of perioperative outcomes. It also helps to determine gaps in current knowledge among operating room nurses in terms of clinical and communication skills within the surgical team.

Methods: An integrative review approach was used to examine qualitative, quantitative and mixed-method studies related to operating room nursing competence. The review was guided by the Population-Concept-Context framework and followed a structured search and selection process. The databases searched included ScienceDirect, CINAHL, PubMed, Google Scholar, Elsevier and EBSCOhost. The literature inclusion criteria were peer-reviewed journals, full-text articles and studies published in English from January 2021 to May 2026. Eligible articles focused on operating room nurses or perioperative nurses, and on clinical and communication competence that enhances knowledge, skills and attitudes in the delivery of care. The methodological quality of the studies was established using critical appraisal tools. Data were extracted, compared and analyzed through thematic synthesis to identify emerging themes. Results: Ten studies were included in the final review. Three major themes emerged from the synthesis: (1) education, training and mentorship; (2) a supportive environment and accurate information flow; and (3) team collaboration and patient advocacy. The reviewed evidence suggests that structured training, mentoring, reflective learning and clinical exposure support the development of perioperative competence. A supportive work environment and clear communication among surgeons, anesthesiologists, nurses and other team members were identified as important for reducing misunderstandings, stress and communication barriers. Team collaboration and patient advocacy were also emphasized as central elements of safe perioperative practice and enhanced surgical team performance. Conclusion: Clinical and communication competence are important components of operating room nursing practice. Strengthening education, mentorship, communication systems and collaborative team culture may support safer and more coordinated perioperative care. This review highlights the need for healthcare institutions to implement evidence-based strategies that enhance competence among operating room nurses in surgical settings.

Postpartum Cardiomyopathy and Torsades de Pointes Secondary to Hypophysitis

S Geethalakshmi, Indira Chakravorty, J. Devachandran — Tue, 30 Jun 2026 00:00:00 +0000

Postpartum hypophysitis is an uncommon inflammatory disorder of the pituitary gland that may present with headache, visual symptoms, or varying degrees of hypopituitarism. Presentation with refractory shock, cardiomyopathy, central diabetes insipidus, severe adrenal insufficiency, and torsades de pointes is exceptionally unusual and may obscure timely diagnosis in the postpartum period. We report a 26-year-old woman, six months after caesarean delivery, who presented with breathing difficulty, lower abdominal pain, recurrent vomiting, weight loss, and fatigue. She had fluid-refractory hypotension requiring vasopressor support. Initial evaluation showed severe left ventricular dysfunction with an ejection fraction of 25-30%, hypokalaemia, bicytopenia, hypothyroidism, and a markedly low morning serum cortisol level of 1 microgram/dL. During magnetic resonance imaging of the brain, she developed torsades de pointes with cardiac arrest and required two cycles of cardiopulmonary resuscitation and electrical cardioversion. Magnetic resonance imaging demonstrated a partially empty sella with a flattened pituitary gland, an absent posterior pituitary bright spot, and a small optic chiasmal lesion abutting the infundibular stalk. Treatment included stress-dose hydrocortisone, vasopressin, magnesium and lignocaine infusions, electrolyte correction, ventilatory and vasopressor support, and heart-failure therapy. Following hydrocortisone initiation, haemodynamic status improved, vasopressors were withdrawn, and the ejection fraction increased to 45% within 10 days. At follow-up, left ventricular function and the QTc interval normalised, while morning cortisol levels remained low and diabetes insipidus improved with desmopressin. This case highlights a rare postpartum presentation of probable hypophysitis complicated by reversible cardiomyopathy, refractory shock, and torsades de pointes, supporting early endocrine evaluation in postpartum patients with unexplained shock.

Biliary Obstruction Caused by Fasciola hepatica Associated with Cholelithiasis: A Case Report

Wed, 08 Jul 2026 00:00:00 +0000

Aims: Human biliary fascioliasis is an uncommon zoonotic infection in which humans are accidental hosts. Its coexistence with cholelithiasis is extremely rare and may mislead the diagnostic process. This report describes a rare case of obstructive jaundice secondary to choledochal Fasciola hepatica associated with lithiasic cholecystitis and reviews international reports published from 2015 to 2021.

Presentation of Case: A 49-year-old male farmer presented with a three-month history of biliary colic. Laboratory tests showed a cholestatic pattern with hyperbilirubinaemia and no eosinophilia. Ultrasonography and magnetic resonance cholangiopancreatography (MRCP) suggested cholelithiasis and choledocholithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a dilated common bile duct with a distal filling defect. Sphincterotomy and balloon sweeping successfully extracted microliths and an adult spindle-shaped parasite macroscopically compatible with Fasciola hepatica. Laparoscopic cholecystectomy was subsequently performed. The patient had a favourable clinical outcome after albendazole therapy.

Discussion: Biliary obstruction caused by adult flukes may clinically and radiologically mimic choledocholithiasis. The literature review identified 26 international cases from 2015 to 2021, with Turkey, Iran and India reporting the highest number of cases. Concomitant cholelithiasis was documented in only three previously reported cases, highlighting the diagnostic difficulty of this parasitic association. ERCP allowed direct diagnosis and minimally invasive management in the present case.

Conclusion: Biliary fascioliasis should be considered in the differential diagnosis of obstructive jaundice in patients from endemic or rural settings, even when gallstones are present and eosinophilia is absent.

Association of Hospital Infrastructure and Resources with House Officer’s Training

Precious Enyioma Onyekwere, Efe-Odenema Otaghogho — Tue, 07 Jul 2026 00:00:00 +0000

Background: The housemanship period is intended to consolidate clinical knowledge and procedural skills under supervision. However, variations in hospital resources may affect the quality of training received by house officers.

Aims: This study assessed the association of hospital resources and infrastructure with the training experiences of house officers in federal and state hospitals in Nigeria.

Methods: A descriptive cross-sectional survey was conducted among 232 consenting house officers and medical officers who had completed housemanship within the preceding two years. Respondents had trained in federal or state hospitals across Nigeria. Data were collected using a structured English-language questionnaire distributed through online platforms. Responses were measured on a five-point Likert scale and analysed using IBM SPSS Statistics version 23. Descriptive statistics were used to summarise participant characteristics and study variables. Questionnaire reliability was assessed using Cronbach’s alpha, which yielded a value of 0.83. Pearson correlation and linear regression were used to examine the relationship between hospital resources and training outcomes.

Results: Most respondents were aged 25–30 years (62.9%), single (91.8%), and trained or worked in state hospitals (77.2%). Clinical facilities, supervision, mentorship, case variety and hands-on experience were rated as good. Access to learning resources, mental health support, and training sessions or workshops were rated poor, while information technology support, emergency preparedness, collaboration and the overall work environment were rated moderate. Hospital resource score showed a significant moderate positive correlation with training score (r = 0.586, p < 0.01). Regression analysis showed that hospital resources significantly predicted training outcomes (β = 0.586, p < 0.001), explaining 34.4% of the variance.

Conclusion: Hospital resources were significantly associated with house officer training outcomes. Strengthening learning resources, mental health support and structured training activities may improve the training environment.

Maternal Exhaled Carbon Monoxide Levels and Placental Histomorphological Alterations in an Urban Niger Delta Population, Nigeria

EMEKA-OGBUGO, Alerechi, PAUL, Chikwuogwo — Sat, 11 Jul 2026 00:00:00 +0000

Background: Carbon monoxide (CO) is a combustion-derived pollutant that reduces oxygen transport and may produce hypoxic stress during pregnancy. The placenta is central to maternal-foetal exchange and may show structural responses to environmental insults. However, evidence linking directly measured maternal CO exposure with placental histomorphological findings remains limited in the Niger Delta.

Aim: This study aimed to assess the relationship between maternal exhaled CO levels and placental histomorphological characteristics among term deliveries.

Methodology: This analytical cross-sectional study involved 240 pregnant women attending antenatal care at Rivers State University Teaching Hospital, Port Harcourt. Maternal CO exposure was assessed using a calibrated Smokerlyzer® CO monitor, which measured exhaled CO in parts per million and estimated carboxyhaemoglobin levels. Placentae were obtained from 69 term deliveries, and a systematically selected subset of 23 placentae underwent histological examination. Data were analysed with statistical significance set at p < 0.05.

Results: All measured maternal CO values were within the low exposure range. Among the 23 examined placentae, 12 (52.2%) were histologically normal, while 11 (47.8%) showed dystrophic calcification of varying severity. Maternal CO concentration was not significantly associated with histomorphological classification (ρ = 0.004, p = 0.986). Placental weight, thickness, diameter, shape, cotyledon count and birth weight also showed no significant association with histomorphological category.

Conclusion: Low-level maternal exhaled CO exposure was not associated with detectable placental histomorphological alterations in this cohort. The observed calcification may be more consistent with term placental ageing than exposure-related injury.