#Evangelia Michail Michailidou*

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Speaker Announcement..!! We’re so excited to welcome our speaker Ms. Evangelia Michail Michailidou, she will present her talk at our CME/CPD/CE accredited 14th International Nursing, Healthcare Management, and Patient Safety Conference in July 25-27, 2024 | Holiday Inn Dubai, UAE. Hurry up Register Now: https://nursing-healthcare.universeconferences.com/registration/ To Register Virtually visit: https://nursing-healthcare.universeconferences.com/virtual-registration/

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Anesthesia Articles in JBGSR

Malpractice in the Intensive Care Unit by Evangelia Michail Michailidou* in Open Access Journal of Biogeneric Science and Research (JBGSR)

Abstract

Error in the Intensive Care Unit (ICU) is a welldocumented and frequent problem. This is understandable as one looks at the complexities of serious disease along with the number of invasive and potentially harmful procedures that are commonly used there. Until recently, allegations of medical malpractice resulting from suspected mismanagement in the ICU were unusual, but there has been a rise the last years.

It is difficult to determine whether the increase in lawsuits is due to a real increase in adverse incidents or to a shift in media perception. There is no question that the aggressive cover-up by law companies dealing in personal injury lawsuits offering to initiate claims on a contingency fee basis has become more common. The Medical Protection Society is experiencing an increasing number of claims generally, and the value of damages awarded is skyrocketing [1].

This includes the insufficient number of ICU beds in the public sector and the acute lack of appropriate nurses in both the public and private sectors. More troubling are the obstacles faced by nurses to apply for critical care and the limited number of critical care nurses graduating. Coupled with a high rate of turnover due to burn-out and greater work openings in other industries and overseas, this leads to a situation where even private ICUs fail to staff their units and retain standards. The mixture of high bed occupancy, chronically ill patients and novice nurses provides the ideal atmosphere for errors and incidents that can lead to lawsuits for damages. The condition is not any different on the medical side. The quality of treatment is that critically ill patients should be treated in ICUs by a team of health providers headed by critical care practitioners with specialty in Intensive Care. Not only surgeons, internists or anesthesiologists without specialization in Intensive Care, which they close holes in the gaps of the health system and do not have the proper education. We are all accustomed to thinking in terms of our primary specialty but this carries many risks. Intensive care training offers the skill to treat the patient comprehensively and systematically, something very important in patients of ICU. Although, we have to mention that there were few unexpected variations in malpractice claims occurring in ICU because of specific medical specialty. Preventive efforts should concentrate on procedures, regardless of the medical specialty, including: 1. Retaining procedural skills, 2. Well-framing of procedural hazards, and 3. Adequately describing post-procedural complications. Skills that are either innate or can be developed through ICU specialization training.

While critically ill patients in the private sector are frequently handled by separate and not suitable always, physicians, these doctors prefer to see the patient at different times of the day, give contradictory orders, and make their own private records. There is no team work usually. Also, under the best of conditions, ICU management often – one would say eventually – results in 'iatrogenic' disorders. John Marshall pointed out that critical disease is potentially iatrogenic and it only exists in people who have survived a life-threatening medical procedure. In addition, the entire structure of serious illness is focused on the effects of original resuscitation attempts or the outcomes of procedures that are regularly conducted in the ICU. It is

Introduction

The plants are part of a rich ecosystem in the soil [1], where bacteria generally colonize the plant rhizosphere and, sometimes, the endosphere. Some beneficial effects for plants may include assistance in getting nutrients and promoting plant growth by modulating growth-related hormones [2]. Other benefits include the reduction of damage caused by phytopathogen [3]. Filamentous plant pathogens can severely attack plants, and in agriculture, this could lead to high economic annual losses [4]. The suppressive soils support soil microorganisms as the first defense against soilborne pathogens. General suppressive soils have a high total microbial biomass, resulting in low protection against multiple pathogens. This strategy is dependent on the quality and quantity of soil organic matter and cover crops that enhance populations of beneficial microbes intended to antagonize associated crop pathogens primarily by occupying plant infection sites [5]. However, specific suppressive soils have a high concentration of specific microbial species and result in high protection against specific pathogens [6].

Cultural practices in agriculture have a strong influence on soil health through physicochemical characteristics and soil microbial communities. Beneficial cultural practices are used to improve soil health and can, in some cases, increase soil disease suppression [7]. According to Schlatter et al. [6], the relationship between soil properties and soil suppressiveness has not been deeply studied. Many different abiotic or biotic soil characteristics have been used to describe suppressiveness, but there is a lack of reliable descriptors.

The plant protection of certain bacteria against pathogens includes a wide range of mechanisms: antibiosis, competition for colonization sites, nutrients and minerals, parasitism, and cell lysis [8]. The protection can be caused by direct action due to antibiotic compounds or indirectly by promoting plant defense as induced systemic resistance [9]. The biological activity is also related to secondary metabolites production, low molecular mass products not essential for bacteria survival produced by secondary metabolism during the late growth phase (idiophase) [10]. These compounds are generally involved in the antibiosis or perform synergism with other inhibitors [11].

This mini-review focuses on some conditions needed to maintain a suppressive soil and the antibiotic compounds produced by the most studied bacteria groups. Because of these molecules' wide diversity, the classification is complex, and several criteria could be taken [12]. In this overview, the work description considers the bioactive metabolites as volatile compounds and non-ribosomal peptides in an integrated and general way difficult to determine the limits between cause and effect and between acceptable complications and preventable negligence [2-5].

Patients who survive a lengthy stay in the ICU are rarely left with life-long complications as a result. Prolonged muscle fatigue, neurological disabilities, and post-traumatic stress disorder involving both the patient and the family are usually described. Who can blame the patient for his anger?

Patients are most frequently admitted to intensive care as a result of an iatrogenic case. Researches showing that more than 21 per cent of admissions had a previous iatrogenic case, the most common being adverse drug disorders, postoperative illnesses and complications of surgical procedures. Personal injury attorneys extend the net extensively and ICU workers may be accused, particularly if the long-term condition is not specifically linked to the initial injury [6].

How do we defend ourselves from legal action that can be both socially and psychologically crippling, not to mention financially catastrophic, if one is not insured? Guidelines and protocols are not always solutions. Hospital managers appreciate directives because they transfer the responsibility to either the writer or the person who failed to obey [7].

The instructions have a position, but are of no value if they are out of date, so impractical that they cannot be complied with or agreed by the workers. There will never be a rule for any case, and there can be no formula for intensive care. By all means have basic rules, but they must be practical, versatile, approved and revised on a regular basis. The most critical thing is to uphold high professional expectations. This means ensuring that all medical professionals and nurses who treat chronically ill patients are critical care experts. In addition, they need to remain up to date with the constantly evolving field of critical care medicine. A multidisciplinary in-house academic curriculum is a positive start [8].

Second, intensive care administration should be focused on a team. The ICU team includes nurses, surgeons, dieticians, physiotherapists and others who contribute to patient care on a regular basis [9]. The team needs a leader, preferably an intensivist, who supports a 'flat hierarchy' and a transparent and efficient contact mechanism. This includes a joint management round where the different practitioners will offer feedback and remind, criticize and help each other [10].

Even a supreme chief cannot defeat a team when it comes to decision-making. Harmonious teaming often ensures that the patient and the family do not get mixed reports about the patient’s success and anticipated results. Holding good notes is necessary, not only as the most effective defensive tool in the (no doubt unlikely) case of a legal problem, but also as part of the contact on patient management. Notes should not only document clinical observations and incidents, but also the explanation why decisions have been taken. It is advisable to retain a copy of one's own reports and share them with colleagues in the patient's hospital folder [11-13].

Finally, maintaining a positive relationship with the patient's family is incredibly necessary, not only to get them navigate emotionally tough times, but also because they are the patient's proxy decision makers. Families need details, but the mistake of overwhelming them with medical care should be avoided. It is more important to give them time to pose questions. It is not generally possible to build a connection with the patient when they are seriously ill, so a follow-up visit after they have left the ICU is an important way to link with them at a personal level and at the same time give them an explanation of what has happened and what the potential effects are. In the case of patients who have died in the ICU, the interpersonal relationship that has developed with their relatives throughout their hospitalization [14].

We ought to have in our mind that most of malpractice cases are brought not out of malpractice or even because of concerns about the quality of medical treatment, but as an indication of frustration about any aspect of patient-doctor or doctor-relatives relations and contact. Intensivists who consider and will react adequately to the emotional needs of their patients are less likely to be sued [15,16]. This can also be transformed into a more accomplished practice of medicine by those doctors who are most mindful of the importance of a positive relationship. For more articles in JBGSR Click on https://biogenericpublishers.com/

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[clinicalsurgery]

Work Harassment: Psychological Bullying in the Workplace of ICU in Open Access Journal of Medical and Clinical Surgery by Evangelia Michail Michailidou*

WH: Work Harassment

Harassment at work is an issue that - if we think about it seriously, knowing the consequences it can have on its recipient - will certainly not leave us indifferent, if not shocking. But it is not just a personal problem that one may face in the workplace. It is a social phenomenon, not only because it concerns the social isolation of one, because more than one person is involved, but also because it occurs in too many workplaces, in all countries of the world and also has socio-economic components, both in terms of etiology and its consequences.

The Harassment at work is not a new phenomenon. It simply began to be discussed and studied as a social problem for the first time in the 1960s. For several years now, the phenomenon of psychological violence, mainly in the workplace and in schools, seems to have grown. avalanche, often having very serious consequences and, several times, even for the rest of the life of its recipients. Anxiety, depression, various physical and mental problems (abdominal pain, headaches, insomnia, hypertension, various phobias, etc.) as well as post-traumatic stress disorder are just some of the possible consequences of a workplace harassment.

But what are the reasons that so many people around the world, minors and adults, individually or in groups, become so sadistically cruel and painless towards other people with whom they coexist daily and who have never harmed them in the slightest? What does this kind of behavior represent? Why does it continue to exist and what can we do to, if not eliminate, at least reduce its incidence? [1-6].

What is considered work harassment?

Workplace harassment or bullying is considered to exist when a person is harassed, threatened or exposed, systematically and for a long time, to various forms of psychological, mainly violence, by another person or a group of people [7,8].

The Harassment at work can be done:

1. verbally, e.g. through ridicule, threats, dissemination of false information in order to reduce the person's reputation, imitation, etc.

2. of course, e.g. through pushing, hitting, destroying personal items, etc., and

3. tacitly, through a complete ignorance of the person, exclusion from common activities, grimaces, sighs, ironic smiles, etc.

The W.H should not be confused with isolated or accidental misunderstandings between two people. Workplace harassment presupposes a very clear power difference between those involved [9-12]. The person being harassed is almost always powerless against him or her or those who are harassing him or her, unable or unwilling to defend himself or herself. To talk about W.H , there should be, as mentioned above, a timelessness in the negative actions against the harassed person that have serious consequences, such as: lack of ability to communicate with others and create social contacts, the collapse of the image and external harassment as well as various negative effects on the workplace, life as well as his physical and mental health. Shame is a key word in cases of work harassment. The harassers aim to make the victim feel ashamed to the point that he or she becomes even more vulnerable and vulnerable to the violence [13-16].

The Role of Group Processes

Studies on how different groups work have shown that in each type of group there are latent processes that largely determine its function and behavior. Two interesting theoretical approaches to understanding group processes are:

The theory of rejection

According to her, the members of each new group that is created need a common idea / perception for that group. During this process, there is almost always someone or someone who does not share the common idea / perception of the group or who wants to leave it. Such a person is experienced by the "team" as a threat to its common effort. Initially, efforts are made to "deviate from the instructions" of the deviant person. When this is not possible, then the "non-compliant" is either rejected or will have to cancel or leave the group or change the group itself, which is very rare [17,18]. The same thing happens every time a new member joins the team. The old members, consciously or subconsciously, take the responsibility of initiating the newcomer in the common values ​​and the rules of operation of the group. The initiation effort can take many forms and intensities, depending on the degree of response of the new member who will either comply or be canceled or, if necessary, expelled. Such efforts aim only at the "survival" of the group, that is, at maintaining its cohesion, as perceived by its own members [19-21].

The Theory of the Scapegoat

The idea of ​​this theory is borrowed from the Bible and wants to describe the rejection of an individual by a group. Targeting someone as a scapegoat - who is ultimately expelled from the group - involves transferring a common guilt to someone else, which relieves the group of the burden of that guilt. The "teamwork" displayed in this case, as well as in that of work harassment, absolves the team members from any kind of individual responsibility. Group action enables each participant to do things they would not even think of doing on their own. In this way, we can understand, on a social level, the various prejudices that exist and that from time to time - especially during difficult socio-economic crises - are reinforced. The aggression then accumulated is, to a large extent, the answer to the fear that prevails and which is transferred to an innocent and, as a rule, harmless target or victim.

At the level of small groups, what usually happens initially is the appearance of various latent behaviors or actions such as: "We do not greet the victim", "We do not inform him of important information", etc. In some cases, things get more serious by hiding important instructions or joint decisions that will seriously expose the victim but possibly the patients also. The common denominator of a group operating in such a destructive way is that this destructiveness is determined by various paranoid latent fantasies that distort reality and create in the group a sense of threat, even of its very existence. Therefore, it begins, in essence, to defend itself against more or less non-existent enemies, such as e.g. a scapegoat.

Who is being harassed?

Harassment at work can occur in any workplace, affect anyone - regardless of age, gender, professional competence or position in the hierarchy - and anyone can be found, either in the position of the perpetrator or in that of the victim. However, there is always some explanation as to why some are affected and others are not. A general complaint is that anyone who differs, in one way or another, from the rest of the group is at greater risk of being harassed at work. Personal characteristics and behaviors, which are blamed and often observed in victims of work harassment, fall into two categories:

1. In passive, low-key and submissive individuals with personality traits such as: wariness, insecurity, physical weakness, low self-esteem and poor self-image, and

2. To victims who cause and have personality traits such as: hyperactivity, irritability, explosiveness and provocation. Such characteristics are considered as easy to irritate and provoke the environment, which facilitates the targeting of these individuals [22-24].

Who is Harassing?

As mentioned above, everything that applies to a victim also applies to the perpetrators. We all felt at some point the need - or maybe we did - to "put in our place" someone we thought "deserved", and we probably all gossiped, consciously ignored or spread a rumor that existed or did not exist for someone. This is by no means synonymous with harassment at work, but it could potentially be a prelude to it. Those who harass are considered to have a more positive attitude towards the use of violence, they want to dominate and impose themselves on others, their point of view should always prevail and there should not be the slightest doubt about their face. They are also experienced by those around them as dynamic people who, however, rarely show feelings of sympathy for others, do not experience guilt, need the admiration of others, lack empathy, easily envy and exploit others and, finally, find it difficult to take initiatives and decisions. In other words, they have personality traits that exist in people with antisocial or psychopathic personality. From the moment, that the W.H it is, mainly, a group phenomenon, it presupposes the existence of companions who are influenced by someone who has a leading role and whom, in some way, they admire or fear. Acceptance of the leader-perpetrator behavior by those around him reinforces, legitimizes and perpetuates work harassment.

How is Work Harassment Expressed?

As mentioned above, the W.H can occur in any workplace, but is more likely to occur in cases where major changes occur in the workplace of ICU, where there are harsh working conditions, stress and dissatisfaction or where there is a lack of organization, ambiguity of roles or insufficient management. It can also arise on the occasion of the conflict between different work cultures, where everyone wants to maintain the routines and the way of working that they know well. It can also occur due to the recruitment of a person who comes from another country, etc. Under such conditions, it is much easier for one or more people to be used as scapegoats or boxing bags. The W.H focuses and concerns, usually in the following two areas:

1. In the object of work of the individual, ie in the burden of his working conditions, e.g. by depriving him of responsibilities for no reason, hiding information about patients, assigning him difficult or unpleasant obligations, etc.

2. To acquire personal character through personal attacks, humiliation, dissemination, sexual harassment or implication, etc.

The Consequences of Work Harassment

Any consequences of a work-related harassment are affected by the victim's personality, personal relationships, workplace relationships, and similar past experiences. The consequences on the victim's self-esteem and self-confidence are serious, usually accompanied by elements of anxiety, depression, despair, difficulty concentrating, intense mood swings, insomnia, fear, various psychosomatic symptoms (abdominal pain, headaches, headaches). shortness of breath, dizziness, hypertension, heart problems, allergies, kidney dysfunction, fatigue, etc.), and even the onset of post-traumatic stress disorder. Some come out of this kind of hell with difficulties that they can manage, while others may have many and serious problems that need the help of specialists and that, in some cases, may even last for the rest of their lives.

It is really "sick" for someone to claim that the exercise of psychological violence is something inevitable in human relationships and that a major cause is some characteristics of the victim. Every adult should be able to manage similar situations in a different and more mature way and, if he cannot, then it is not the fault of the recipient of his personal shortcomings and repulsions. Such arguments have no research support. The personality of the victim does not play a special role in his choice as a recipient of psychological violence. What is happening is the exact opposite, that is, the personality of the victim is disturbed, due to the psychological violence against him.

Some argue that victims of work harassment are often people who are strongly opposed to certain choices of the workplace management, to its authoritarianism and who, in general, do not easily submit to its authority. If the management of a workplace first makes an employee a scapegoat or openly targets him, then this is primarily the reason why this employee is subjected to psychological violence by the rest of the staff, and not his attitude towards the management.

Other causes include the following

Reorganize the team or hire a new manager.

Someone who can be favored or appreciated by the management.

1. Someone who refuses to do something that is asked of him and that he considers to be -or / or that may be- immorally correct.

2. Someone trying to protect a co-worker from being harassed at work.

3. Someone who has pointed out the existence of injustices, bad conditions, unacceptable behaviors or abuse of power in the workplace.

The Silence and Tolerance of Colleagues

People say that "Fear guards the ballast", and fear, in the case of work harassment, often leads to "Silence of the lambs", that is, of colleagues. In this way, the victim remains usually helpless, which often creates feelings of guilt and shame in the non-participating colleagues. One way to get rid of these torturous feelings is to blame the victim as solely responsible for the ordeal he or she is experiencing, which further strengthens his or her isolation and exposure to the perpetrators. The situation becomes even more tragic for the victim, when the passivity of his colleagues turns into an active applause of the psychological violence that takes place. We could say that the colleagues, in this case, become the audience of a Roman arena that with its applause determines the limits of the victim's punishment.

Conclusion

The truth is that the W.H It has much larger dimensions - I would say scary - than many of us believe and it will not, of course, be eliminated by itself. The issue needs to come to a wide public debate in order to sufficiently highlight its serious consequences both on a personal and socio-economic level, but also to make appropriate proposals for the best possible response. All researchers on the subject agree that the responsibility lies not with the victim but with the way a workplace is structured and operates. When people feel insecure, anxious, stressed and afraid, they easily look for a scapegoat to shoulder what is unbearable for them and, thus, maintain an illusion of internal and external balance. It is necessary to have an effective legal framework that protects the recipient of psychological violence, but also each employer to ensure a framework of employment relations that prevents as much as possible the occurrence of such phenomena. The responsibility of each administration is great. Because knowledge is always a prerequisite for any optimization and change, discussions and open dialogue in the workplace before and / or when there is an W.H. It is especially important that they are done, if possible, even with the assistance of an external expert.

Regarding our Journal: https://oajclinicalsurgery.com/ Know more about this article https://oajclinicalsurgery.com/oajcs.ms.id.10010/ https://oajclinicalsurgery.com/pdf/OAJCS.MS.ID.10010.pdf

[clinicalsurgery]

Toxic Work Environment in the ICU Workplace in Open Access Journal of Medical and Clinical Surgery by Evangelia Michail Michailidou*

Opinion

Everyone happens to have a bad day at work, especially when it comes to a closed department and a stressful environment such as the ICU. It may be the fault of an unsuccessful medical procedure, a patient with a poor outcome, the traffic on the street, a dissatisfied relative patient or, more importantly, the poor cooperation of the department staff. Whatever it is that worries us, it is enough to make us lose our mood and not be able to wait until it is time to go home. But there is a difference between "having a bad day" and feeling sick at work every day. The first is a slight inconvenience, something that goes away and comes depending on the weather and conditions. The second, however, we feel is "poisoning" us internally and is a danger to our mental balance and our health. The reason for this is no other than a toxic work environment. An environment that is negatively charged, strongly affects us emotionally and makes us feel highly stressed and disgusted about our work, with the risk of not being effective with our patients.

It is not difficult to recognize if the environment in our work belongs to this category, as long as we see how the employees (medical and nursing staff) work with each other. If the atmosphere is constantly electrified, there are major communication problems, constant pressure and a complaint, and then something is wrong. It is important to stay away from toxic people and environments. Not only because they endanger our health, but also because they hold us back and do not allow us to evolve. You may think that it is a luxury to complain about one's job at a difficult time. However, living an unbearable daily life, in a job with which you are intolerant, is not a solution and will quickly lead you to a dead end.  That is why we have to think and see what goes through our hands and what we can do, to make this reality more bearable.

We have to find the Positives

To be able to deal with negativity, stress and madness in a bad work environment, we need to change a little the way we look at things. What we need to do is find the positives in every situation, so that we can focus there and get our attention from the negatives. If, for example, we are in an ICU which is a good opportunity to gain experience or an opportunity for a better position in the future, then we should think that this is a step that will help us climb higher.

We set our Limits

The truth is that setting the right boundaries is not easy. It is very easy to confuse assertive communication with aggressive communication. Especially in the workplace it is a challenge, as we have to keep a delicate balance. However, if we want to stay reasonable and keep our own mental health in balance, then we must be able to say no and set our limits correctly. Almost always, the problem with boundaries lies in beliefs. One is afraid to speak up and express one's opposition and feelings. This is either because he thinks it makes no sense, as no one will care, or because he feels that if he does, disaster will come. However, passive behavior can only cause harm, and if we feel oppressed, it is our responsibility to civilly draw a fine red line. The more we do not, the more others will push our limits.

To Learn to put our Limits on the Demanding Workplace of the ICU and to Survive even if we are in a Toxic Work Environment

We do not take part in fights

A toxic work environment is a breeding ground for conflict, disagreement and, of course, intense drama. And in all this, it is very possible that we, even indirectly, get involved in such situations. Either trying to support one side, or wanting to change another's opinion and show him that he is wrong.

Whatever has happened, all this drama adds intensity and charges us with even more negative emotions. So if we want to gain our composure, it is important to avoid conflicts as much as possible and of course not to participate in disagreements and quarrels between others.

We must have a support system

It is important, when we are constantly charged with strong emotions, to be able to get them out of us. To be able to do this, we need to be able to talk to family, friends and generally loved ones in our lives. That is, with people who constitute our so-called support network. This is a network of people who care about us and can listen to us and support us. These networks are an essential component of a balanced life.

It is good to avoid being open to people in our workplace because relationships and interests between colleagues change and we can become vulnerable by showing our weaknesses. Often, when they are absent, depression begins and they look for a way out of their problems in various activities that make them forget, but this is just a temporary escape from the problems.

We must not pay attention to gossip

Gossip and constant comments from other colleagues are a reality in all ICUs, but in any toxic work environment they have the first say in everyday life. Often, it is one of the parameters that can influence the thoughts we do and how we feel. Especially if gossip targets us and hurts us every day. However, all of these are often assumptions and products of fantasy. Unfortunately, we can not control what others do and say. But what we can control is ourselves and our reaction. So do not let the various stories and comments affect us. We need to stop thinking about what may or may not have happened and turn your gaze to reality and the data that exist.

We need to make sure we are not part of the problem

We may want to help a colleague in his work or emphasize specific problems. However, constantly correcting others or complaining all the time does not help much. Even if we have the best intentions, instead of helping to make things better and smoother, we make them actually worse. Unfortunately, if we are part of the problem, it is difficult to understand and deal with it, as one does not easily admit one's mistakes and guilt. However, if we want to change something and survive in a difficult and toxic work environment, we must first make sure that we do not contribute to the problem in our own way. Otherwise, it is very likely that negativity will follow us everywhere, even if we change ICU workplace.

Regarding our Journal: https://oajclinicalsurgery.com/ Know more about this article https://oajclinicalsurgery.com/oajcs.ms.id.10009/ https://oajclinicalsurgery.com/pdf/OAJCS.MS.ID.10009.pdf

[clinicalsurgery]

The Partnership between Surgeons and Anesthesiologists in Open Access Journal of Medical and Clinical Surgery

Abstract

Teamwork is now recognized as essential to healthy, high-quality perioperative treatment. The partnership in-surgeon – anesthesiologist dyad is perhaps the most important aspect of the overall team success. Well-functioning collaborations are conducive to secure, successful treatment. An unhealthy relationship can foster unhealthy conditions and lead to a negative outcome. And there is no study on this interaction, about what fits well or not well, and what can be done to improve it. This essay discusses the practical and unhealthy facets of the relationship, describes certain common perceptions of each occupation and calls for study to further identify and appreciate how to strengthen working relationships.

Teamwork is one of the most important factors of perioperative patient care for the members of the operating room team. However, the largest uncertainty of the impact of team success on results and protection can be correlated with one dyad in the unit: the relationship between the surgeon and the anesthesiologist. If it is accurate that leadership dyads are a crucial factor in the protection, consistency and/or efficacy of the operating room staff, then the dyad of the surgeon and anesthesiologist is the dyad we should strive to learn and maximize. The triad partnership between the surgeon and the anesthesiologist and others is also crucial to maintaining safety, efficiency and consistency. The relationship between the two physicians who often share, give or fight for leadership has the ability to allow or hinder performance that may exceed that of the other dyads or multiple, parallel interactions.

What do we know about the Relationship between a Surgeon and Anesthesiologist?

In this sense, "relationship" is about how well two people get along, how well they support and trust each other and their views, how much they depend on each other for input, how willing they are to keep each other aware of the acts that involve their dyadic partner. There is evidence that refers to certain scientific facets of the interaction between a physician and anesthesiologist. Coordination and dispute have been studied and recommendations have been made to resolve them. Conflict in the operating room between individuals — mostly between anesthesiologists and surgeons — is a big problem and has been encountered or observed by virtually everyone involved in the operating room. Although conflict linked to clinical choices is normal and safe if properly handled, personal disagreement is not safe and is seldom in the best interests of the patient [1-3].

Conflicts can occur due to the vagaries of work and human beings, particularly though there is a relatively healthy relationship between the parties. It may also be a noticeable and potentially harmful representation of a suboptimal or toxic relationship. Whether the disagreement is troublesome depends on how it occurs and how the individual handles it. Too much, this isn't done properly. The length of a surgeon – anesthesiologist partnership is variable - sometimes people have only just met; others have worked together for a long time.

Familiarity often offers mutual trust that tends to defuse conflict; at other times, it creates an ingrained unhealthy partnership and mistrust. A variety of facets of conversation, function expectations, various mental styles, and the tone required activating speech, and related issues have been discussed in multiple research. There is no focus on any of these papers on understanding the origins or how to enhance the reliability and instability of the surgeon – anesthesiologist dyad. Unfortunately, little is written about successful relationships in health care, particularly examples of good working relationships that are more likely to be more prevalent in some environments than in others. There is justification to conclude that they make a substantial contribution to productivity, protection and performance.

Personal Remarks & Observations

Over my experience of patient safety and efficiency, I have been drawn to this subject by personal insights and interactions with anesthesiologists and surgeons. The word "tribe" should be used to identify the various occupations in the operating room, e.g. physician, nurse, anesthesiologist, surgical assistant, for insight into how tribal instincts and actions can be detrimental between tribes and culture [4-7].

a. Observation 1: While the dyad is fully efficient, it is of immense benefit to the patient; one will support and "rescue" the other. And a healthy working relationship (for all) provides a far more friendly working atmosphere.

b. Observation 2: While the dyad is broken, it can — and does — often contribute to damage and sometimes produces an uncomfortable and often dangerous working atmosphere.

c. Observation 3: Each side of the dyad has some impressions of the other side which are damaging. If I had to ask each other what they think of the other profession in general, the first reaction would contain certain comments that are complementary. (Corollary: both will share similar perceptions with other medical tribes when working together)

d. Observation 4: At times, each side of the dyad applies motives to the other that are not purely in the best interests of patients.

Poor Impressions of Surgeons for Anesthesiologists

Such negative views of anesthesiologists include: lack of understanding of "anesthesia-related" (as opposed to surgical) issues; lack of comprehension or appreciation of the degree of blood loss; persistent underestimation of surgical time; Failing to warn patients and caregivers about the chances of success and the extent of the difficulties of rehabilitation following surgery; failing to give proper attention to patient health needs and patient desires; and avoiding people to chat about safety issues.

Poor Views of Anesthesiologists by Surgeons

Several of the negative views of anesthesiologists by surgeons include: more concern with completing their day on time than meeting the needs of their patients; unreasonably eagerness to postpone a operation based on unjustified concerns; lack of respect for the need to follow a schedule; undue turnover times; Distraction and inattention during surgery; inability to explain major improvements in vital signs to the whole team; failure to keep the team aware of the need for vasopressor support; lack of awareness of the interaction between the patient and the surgeon; and reluctance to adjust the anesthetic strategy of the need for the surgeon of maximize surgical technological requirements.

Related Principles

Surgeons and anesthesiologists have different roles that can lead to varying beliefs and reasons for what they think best for the patient. The group in which everyone was educated has established a collection of principles and ideals that are consistent with what has traditionally sustained its performance over the years. Haidt examines extensively how beliefs are formed in our cultures and how they influence our view of the "other." As all tribes, the collective performance of the group can contribute to negative views of other groups. As a consequence, some discord between two people from separate tribes is expected. Hope for enhancing the dyad efficiency for the good of the patient derives from the awareness and appreciation of discrepancies and attempts to overcome or satisfy them.

What does a Perfect Relationship Look Like?

As patient, someone, expects his surgeon and anesthesiologist to operate in full peace, setting aside their personal concerns for my wellbeing and well-being. Surgeons and anesthesiologists should develop a better understanding of the expectations and limitations of each other's professional interests of patients in general as well as for any particular patient. This will have risen long enough in advance to value the time taken to resolve these questions. (Ideally a day or so in advance, or even a significant "huddle" before getting the patient to the operating room. Immediate pre-surgery time might be necessary for certain prosaic needs.) Should be open to and willing to hear the views and viewpoints of the other, even though they appear to conflict with their own field of expertise. It will only work by inspiring to ask questions. Each of them will often begin with an extension of the "simple presumption" (from simulation-based debriefing) to the other: "I assume you are educated, knowledgeable, working your utmost to do your best and striving to change, and behaving in the best interests of this patient and the institution." Where there is a genuine dispute as to what choice to take, the discussion will rely on what is best for the case, not who is best. Examples of missed factors that may lead to an optimum partnership include interdisciplinary morbidity and mortality or case analysis and an efficient huddle.

Over the years, we have studied and survey unidisciplinary and interdisciplinary quality improvement boards in hospitals. They do have benefits and drawbacks. Overall, it appears to be extremely beneficial to discuss / debrief difficult cases or adverse effects as a team. There are obstacles to doing this, such as various job schedules, or the need to be secure outside one's own community to say something that may be important. Thankfully, those interprofessional debriefings appear to be growing such that we can assume that this will have a positive effect on the overall work.

What kind of Analysis will lead to Deeper Understanding?

Investigations into ties between members of the perioperative team did not answer any of the concerns I asked at the outset. Surveys, focus group discussions, observational experiments, crucial event or comprehensive ethnography may all be used to shed light on the problems that render the surgeon-anesthesiologist dyad highly efficient or totally dysfunctional. Case studies of examples of both stable and unhealthy relationships, and in particular more complex facets of partnerships that can relate to under-optimal treatment, will help increase awareness about how habits and actions can lead to the best about treatment or the worst of care and everything in between. Replicating that with a focus on the relationship between a surgeon and anesthesiologist, both parties might shed light on the issues.

Another field of research and understanding that can be beneficial is that of emotional intelligence. Emotional intelligence is increasingly seen as essential for good relationship management.

Discussion

What can be done in the meantime, until we have further proof?

If you are an anesthesiologist or surgeon and think that what I am recommending is worth pursuing in order to enhance the perception of your patients and your pleasure and sense in your clinical practice, what can you do in the absence of scientific evidence?

Some ways to resolve the issue

Asking a colleague of the other tribe regarding his or her impressions of the members of your tribe.

Have a conversation about the origins of these experiences.

It's usually better to do this on a relaxed meal or cocktail rather than on an "other phone" scenario.

Organize a concentration or dialogue group, with a few members of each tribe.

The effectiveness of such activities will be improved by a competent facilitator.

One subject for a focus group may be the specific recognition how leadership can be communicated or identified in various contexts.

Any time a circumstance happens that makes you realize like a relative from the other team is doing something that appears to be more in their own best interest than in the patient's interest, interested and metacognitive. Think what other theories there may have been. If you can do it in a non-threatening, non-accusatory manner, you can ask the person; however, it is not easy to be able to pull it off with genuine sensitivity and complexity. This is an ability that needs preparation and practice. If you are good enough to work in a hospital that has a simulation curriculum and a full operations team experience, make advantage of it or build a chance to join.

If the concerns mentioned here appeal with sufficient intensity to a large number of surgeons and anesthesiologists, there is definitely a role that the national association of Surgeons and the National Society of Anesthesiologists will play in addressing the issues and moving towards a more desirable state of affairs. In view of the geographical constraints, I have not addressed all facets of this subject that are important to the comprehension and enhancement of the surgeon – anesthesiologist dyad results, e.g. operating in set versus shifting teams; relationships with other team members; output pressure; job conditions (independent or staff); Academic versus private practice. This may be part of a wider discussion and discovery phase.

You may be a surgeon or anesthesiologist for whom none of this is important and who is lucky to have a close friendship with a surgeon-anesthesiologist. However, we have ample reasons to conclude that the shoe works for everyone, and that even the best people and best partners have a tough time. Certainly, most of us know of many cases where issues in a surgeon-anesthesiologist relationship have become dangerous to patients. At the end of the day, no matter our own relationship concerns, we will all accept that keeping patients safe should be a matter of utmost concern.

Regarding our Journal: https://oajclinicalsurgery.com/ Know more about this article https://oajclinicalsurgery.com/oajcs.ms.id.10002/ https://oajclinicalsurgery.com/pdf/OAJCS.MS.ID.10002.pdf

[clinicalsurgery]

Toxic Work Environment in the ICU due to a Problematic Director and Ways to Deal with it in Open Access Journal of Medical and Clinical Surgery by Evangelia Michail Michailidou*

Opinion

Every day we encounter in our work people who are toxic, negative and generally difficult to work with. Toxic people are all around us, things get worse when the toxicity comes from our manager. Toxicity in the workplace is something that exists in even the most modern ICUs. Even if you leave a job due to the toxic work environment in that particular ICU, no one can guarantee that you will not meet toxic people in the next one. The point is not to escape, but to overcome it. If you encounter toxic managers at work, there are three things you can do to improve your relationship with them and help change the culture in the ICU.

Understand their behavior

When someone reacts, speaks or behaves negatively, stop for a moment. Put yourself in his shoes before defending or reacting. Many times, we feel offended when someone misbehaves, but is that the whole story?

We all see things through the eyes of our own experiences. But this limits our ability to empathize with people in their good and bad times. Our ability to accurately interpret the actions of others is at the root of the many cultural differences that arise. To understand a colleague, we need humility, thoughtfulness, and a willingness to look beyond that, and to consider time and space. But how can this be applied to the ICU work environment? Sometimes the best way to deal with these challenges is to understand toxic behavior.

Try the following Exercise the Next Time you see a Toxic Behavior at Work

Remind yourself that most people think they are good. They do not imagine that they can be bad, especially in their own history. The next time you encounter a toxic person, ask yourself how he or she would tell his or her own story.When you can shape the narrative of his life, you will be able to understand this person. Compassion is a powerful force that allows you to build meaningful relationships.

Think about your Reactions

Successful leaders and managers know how to control their emotions. They do this by cultivating their emotional intelligence, which helps them stay calm in times of crisis and deal with conflicts. They are not attracted to selfish battles and escalating arguments. You may be thinking, "How can they do this?" The truth is that they need years of conscious work to improve themselves. However, you can do the following exercise: imagine yourself leading the way. A truck deviates from its course and you begin to feel anxiety, nervousness, terror and fear.

Imagine a sign that reads "ANXIETY OUT OF OPERATION"

This sign reminds you to be calm, careful and maybe use your humor to deal with the situation. You can smile when you see the sign, which is a reminder to calm down and deal with the situation later in peace. You may have encountered the following situation at work: your colleagues accuse you of mishandling, in their view, the management of an incident by senior ICU executives. Normally, the first reaction is to be upset, angry and ashamed. But you can calm down and see things clearly. You can ask for help to improve the people who slandered you without ever having to mention anything further.

Deal with Toxicity with Cooperation and Compassion

Believe it or not, most toxic people do not understand that their behavior affects others, and in fact we are all guilty of it. Their tendency to interrupt, shout or react negatively is not premeditated. This is true when people are unaware of the root cause of toxicity. The next time you witness a toxic behavior, use it as an indication and show a spirit of cooperation. Collaboration is a great way to help someone stop some unintentional stressful behaviors. You can also train other colleagues and more residents. In modern work environments culture is common and most people are willing to see mistakes in their behavior if you approach them with compassion, but unfortunately not always. Sometimes toxic behavior is simply intentional as a result of malice and competition.

Toxic Managers

Is your manager the source of your stress at work? This is not uncommon and he may be dealing with his own mental health issues. This does not make things easier but there are solutions you can try to improve the situation. Sometimes when we improve our knowledge of different personalities and deal with them it allows us to work with people very different from us. Here are some types of managers.

Irritable

It can be overly emotional, irritable, intense, unpredictable, reactive or even intimidating.To approach him: Stay calm and resist the reaction. Often people who behave this way have high levels of stress and any unwanted or unexpected reaction can make the situation worse. When they are calm, try to clarify what they expect from you.

Paranoid

He rarely trusts others, he feels that his subordinates or other managers want to fire him or take his place.To reach out to him: Do not challenge him or ask him questions. Give him all the information about your job when he asks you to. Do not take risks or take initiatives without first obtaining permission.

Avoids risks

He is usually afraid of being judged or criticized or he is afraid of making justified changes. He may avoid change and want to explore everything in detail before doing anything. To reach out to him: Do not go ahead and stay committed to the procedures and responsibilities given to you. Do not take any risks and do not make changes.

Tough

It seems difficult to read and is not very sociable. It shows no compassion or emotion. Communicates only when necessary and even then is quite limited.To reach out to him: Sometimes these people prefer written communication to have time to think and articulate their answer. Try to give them space and limit random communication. Resist the controversy.

Undecided

These people behave well in front of you but may speak badly behind your back. They find it difficult to support their point of view so they avoid disagreements, resist them or sabotage what they do not like or do not do what they say. To reach out to him: Do not disagree or argue with them. Ask exactly what they want and how they want it. Do not assume that they will agree with you or support you when needed.

Arrogant

These people believe that the universe revolves around them and that this is how things should be. They do not react well to criticism and will rarely admit that they are wrong. To approach him: Flattering comments usually work well and remember that you may regret any question or accusation you make in their face if something goes wrong. Just state the problem you have and ask for their wise advice on how to solve it.

Dramatic

They may enjoy being the center of attention or focusing on something that excites them or getting angry about something else. To approach him: Pay attention when he is in front and let them take the floor. Resist giving advice or getting attention from them.

Impractical

These managers may have strange, unwarranted, or inapplicable ideas. Their vision is impossible to execute, or they may not communicate effectively.To reach out to him: Try to understand their ideas and look for ways to implement them. If your ideas include, ask what your requirements are and how success will be assessed so you know your share of responsibility.

Continuous supervision and intervention

This type of manager is obviously afraid of criticism or constantly judges himself, which is why he is obsessed with the details of the job that no one else does like him. His demands are irrational or he may not let you get involved in every step of the way.To approach him: Of course, you have to pay attention to detail with this boss but you can also find ways to make your work meet certain standards.

Ask for help

If the situation with your manager gets worse, talk to someone who can help you. You may want to express your concerns about your well-being instead of enduring their attitude. Of course, this is not the process if there are threats, violence, intimidation or harassment. In these cases, follow the procedure provided or think about what you are willing to endure and for what purpose.

See this situation as an opportunity

You cannot run away from toxic people. Obviously you cannot change them. Only your own behavior can be controlled, for this the best thing you can do is stand on your own two feet and be compassionate. Think about this: What does not kill you makes you stronger! For this be strong. Do not accept toxicity, learn to manage it and create an environment in which everyone will want to be a member.

Take care of your own well-being

It is unlikely that your manager intends to cause you anxiety and worry, but if that is the case, it may be causing biological changes in your body. These chemical changes that occur in our body as a result of chronic stress or anxiety are responsible for all health problems from cardiovascular to autoimmune diseases and mental health problems.

If all else fails, get ideas from others

If all else fails, get ideas from others. While you may need your job if you no longer enjoy it because of this relationship and it negatively affects your well-being, you may need to make the decision to find another job at another ICU. Do not see it as a failure or giving up, it is an important decision for your own health.

Regarding our Journal: https://oajclinicalsurgery.com/ Know more about this article https://oajclinicalsurgery.com/oajcs.ms.id.10008/ https://oajclinicalsurgery.com/pdf/OAJCS.MS.ID.10008.pdf