Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

Cecil B. Drain


Smoke (plume) is produced when tissue is cut or coagulated with lasers or electrosurgery devices during surgery. Research has documented that surgical smoke creates a serious workplace hazard for over 500,000 healthcare workers. Toxic gases create an offensive odor, small particulate matter causes respiratory complications, and pathogens may be transmitted within the surgical smoke to the surgical team. Previous research notes that smoke evacuation recommendations are not being consistently followed by perioperative nurses.

The purpose of this study is to determine key indicators that are associated with compliance with smoke evacuation recommendations by perioperative nurses. The Diffusion of Innovation theory by Rogers serves as the model since it describes key indicators for the adoption of an innovation, including individual innovativeness, perceptions of the innovation attributes, and organizational innovativeness.

A descriptive explanatory/exploratory study was conducted using a validated and piloted survey that consisted of both expert-generated questions and adaptations of previously proven measures. A population of AORN (Association of periOperative Registered Nurses) staff nurse members who have e-mail addresses (N=20,272) was targeted as the universe. A random sampling consisting of 4000 nurses were invited to respond to a web-based survey during a two-month period. There were 777 completed responses representing a 19.4 percent response rate.

The SPSS statistical computer package was employed to analyze the data using frequency/descriptive statistical techniques and bivariate analyses to examine the relationship between the key indicators and compliance with smoke evacuation recommendations. Major findings reveal that specific key indicators influencing compliance include increased knowledge and training, positive perceptions about the complexity of the recommendations, and larger facilities with increased specialization, interconnectedness, and leadership support. The study outcomes are planned to be disseminated via lectures and articles.

Promoting a safe surgical environment is a top priority for perioperative nurses. By identifying key predictors that influence compliance with smoke evacuation practices, a better understanding of the many factors that influence perioperative nurse practices is fostered. Nurse training programs can be developed that directly target and address these key predictors so that a safe and healthy surgical environment free from surgical smoke can be promoted.


Scanned, with permission from the author, from the original print version, which resides in University Archives.


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