The doctor-nurse relationship in the operating theatre.
The operating room (OR) is a place requires close and careful .. safety helps doctors, nurses and all other healthcare professionals constraints; relationships; the safety and the sterility such as aseptic technique; situation. The surgeon depends on the nursing team to provide the necessary instruments, The operating theatre staff must be vigilant to eliminate pathogens and keep the should be permitted in the operating theatre; (2) personnel and doctors must follow Personal attitude influences all aspects of hospital relationships–; from a. ever, if responsibilities shared by operating room nurses, surgeons and the administration plosion hazards and oversee aseptic technique. Depending upon the relationship existing at protect the patient, nurses, doctors and others.
Participants Total enumeration was utilized to gather respondents in the investigation. Twenty one operating room nurses were recruited from four identified hospitals in Samar, Philippines, namely; Calbayog Sanitarium and Hospital, Our lady of Porziuncola Hospital Inc. Inclusion criterions were set for study participation among nurses as follows: In data gathering, respondents were approached personally and professionally at the time convenient to them.
After a given time, the test questionnaires were recollected. Furthermore, respondents were evaluated as to the extent of practice of sterile technique during their tour of duty in a period of one month. Camillus Hospital, and Samar Provincial Hospital prior to the conduct of the investigation. Prior to the interview, consent forms were given to the respondents and have them read and signed it.
Confidentiality and anonymity of the respondents were maintained by only a code number on the questionnaire. Instrument The investigators utilized three-part questionnaires in gathering necessary data. Part I was composed of the demographic profiles of the respondents.
Part II is a 20 item test divided into two sections; 10 items multiple choice and 10 items alternate response; the maximum possible score is It was designed to measure the knowledge of the respondents on the principles of sterile technique. The higher the score, the greater the knowledge about the sterile technique the participant has. Respondents were asked to indicate their answers by encircling appropriate option.
In order to evaluate the extent of practice of sterile technique, the investigators utilized Part III, an evaluation checklist which was rated by the respondents in a fixed five point likert scale. Scores assigned to each item are between 1 to 5 points as follows; Greatly Done, Well done, done to a moderately extent, done to a limited extent, and Not done.
Both the questionnaire and the check list were drafted in a structured format and they were used in a pilot test before being applied to the respondents enrolled in this investigation. Refinement and re modifications were done on the basis of pretest results.
The doctor-nurse relationship in the operating theatre.
Furthermore, questionnaires were validated through expert validation by five experts in the field of peri-operative nursing. Data Analysis Descriptive and inferential statistics were utilized to analyze the data.
Descriptive statistics included frequency, percentage, mean and standard deviation. Pearson r coefficient correlation was utilized to determine correlation of selected variables.
Data were analyzed using SPSS version Majority of the respondents were female As to length of clinical experience, most of the respondents have rendered 1 to 5 years of service Table 2 presents the cumulative scores of the respondents on the two-part questionnaires on sterile technique. Majority of the respondents Table 3 depicts the information obtained from respondents regarding the extent of practice of sterile technique.
Mean scores were computed for each of the indicators which ranged from 4. It aims to explore the experiences of promoting quality perioperative patient care by OR nurses. These experiences were derived from their encounters with difficulties and problems as OR nurses during perioperative nursing care. Their most significant experiences of as OR nurses were also examined.
Results of the study can be used as bases for competency review in the perioperative nursing which is crucial in identifying and guiding clinical and professional behaviours to uphold and preserve quality and safe perioperative nursing care. A total of 23 OR nurses were asked to participate in the study. These OR nurses are permanent or regular hired nursing employee in the OR for no less than 6 months.
They had equally rotated as a scrub, circulating and recovery room nurses who performs the perioperative roles and responsibilities. Supervisor of the unit were not included in the study due to the scope of responsibilities they handle. Nurse trainees were not also included as participants in the study. The first hospital is a bed capacity with a total of 7 operating theatres: Fourteen 14 nurses from this hospital participated in the study, ten of them are senior nurses and four are junior nurses.
They are rotated respectively in early shift 7am to 3pmafternoon shift 3pm to 11pmnight shift 11pm to 7pm. They have direct interaction with the surgical patients and work in collaboration with the surgeons, doctors, nurses and ancillary personnel and other members of the health care team. The second hospital is a bed private hospital with a total of three operating theatres: Likewise, their post- operative care management is transferred to the post- anaesthesia care unit PACU adjacent to the OR unit.
A total of nine OR nurses from the second hospital participated in the study. The nine nurses are all senior nurses who rotated respectively in early shift 6am to 2pmafternoon shift 2pm to 10pmnight shift 10pm to 6pm. Accordingly, these OR nurses have direct interaction with the surgical patients and work in collaboration with the surgeons, doctors, nurses, ancillary personnel and other members of the health care team. Research Instrument Semi-structured interview was used to collect the needed data.
An interview protocol which composed of ten open-ended questions was formulated for the research. Five questions were asked regarding the perceived problems and difficulties OR nurse in providing perioperative nursing care: What are the common problems you encounter as you provide preoperative care? How do you feel about these? Describe your experience working together with the members of the surgical team surgeon, anesthesiologist, nurse, etc.
What are the common problems you encounter as you provide intraoperative care? What are the common problems you encounter as you provide postoperative care? How do you address or solve these problems? Five questions were asked regarding the significant experiences of as an OR nurse: Describe your experience after the 8 hours of rendering perioperative nursing care to your patient.
What do you think is the implication of these experiences to your own personal and professional growth as a nurse? What is the most difficult part of being an Operating Room nurse? What recommendations can you suggest addressing these problems? Have you ever been burned- out? If yes, what led you to it? What did you do about it? Ethical Considerations Permission and clearance was secured to conduct the study from the Nursing Service authorities of the hospitals.CUSP: Effective Patient and Family Communication
Basic principles guiding ethical considerations for research were explained to the respondents to fully inform them about the aims, methods and benefits of the research and to secure their consent to participate in the study. A invitation letter explaining the aim and objectives of the research was provided. Anonymity and confidentiality with regards to the information to be obtained was distinctly emphasized.
Respondents were informed that they may decline or withdraw from participating at any time, and that responses will not be in any way linked with them as an individual or as an employee of the institution they are working for. They were asked to affix signature over their print name to signify their informed consent as participants of the study.
Data Analysis Methods of qualitative data analysis described by Polit and Beck and Bernard and Ryan were used to analyze the qualitative data from the semi-structured interviews. The whole process which involved coding and bottom-up approach of analysis and constant comparative method were used to determine data saturation and identify core categories and central themes.
The third author conducted the audit trail of the data as a form of validation. Problems and Difficulties of the Operating Room Nurses in the Perioperative Phases of Care Figures 1 and 2 show the overall summary of the results of the qualitative study. Three themes emerged from the data also called Level II Codes: Significant Experiences of Nurses in the Operating Room Figure 2 shows the collapsed thematic analysis of the significant experiences of an operating room nurses.
Overall, the themes that emerged include: Problems and difficulties of the Operating Room nurses in perioperative phases Figure 2. Significant experiences of operating room nurses Table 1. These incidents caused feelings of frustration, disappointment and inconvenience on their part as OR nurses. However, anticipation is a daily essential part of skilled nursing care.
Over the years, the significance of nurses anticipating for the needs of the patients raises the idea that the focus should be about excellent care of patient from the very beginning, especially on the phase wherein necessary preoperative preparations must be completed before the patient is wheeled in the operating room.
Martinez, stressed that it is a disappointment when professional nurses have not fully acquired skills that will allow them to provide effective nursing care.
Since patients typically are dependent on their daily activities due to their medical conditions, nurses who attend to the patients before operation should optimize the functions of the patients. Scenario 3 On a busy elective OT day, onco-surgeon was going to operate a year-old patient of carcinoma thyroid with neck metastasis. Other routine cases were also on the list. Anesthesiologist requested the chief of the surgery to allow the onco-surgeon to operate on a table having invasive monitoring as the case is complicated.
In view of patient's safety intervention from the chief of anesthesiology was sought, and patient was put on invasive monitoring table. But firm stand taken by the chief of anesthesia in favour of patient safety was again an example of collaboration.
Scenario 4 There is a common problem that surgeon do not adhere to the OT timings. They would come at their own convenience and then starts dictating the anesthesiologist the course in which patients would be operated.
Sometimes fasting children and even diabetic patient, who should be operated as first case, are ignored. When the surgeons are confronted on these issues, disagreement rapidly degenerates into shouting match and many a time witnessed by the patient's also. This disruptive behavior sometimes takes the form of abusive language, derogatory remarks and physical confrontation.
This leads to hostile work environment, and patient care is compromised as dealing a physician with disruptive behaviour is time-consuming and futile. The best mechanism to deal with such kind of behavior is avoidance.
Maintain good communication skills Always keep the communication lines open and show mutual respect and never forget the primary goal- to ensure best patient care.
Avoid engaging in actions that threaten your reputation. Be vigilant how your behavior and actions reflect on yourself. Setting ground rules Identifying and agreeing to ground rules at the outset establishes an efficient approach to get the work done, and difference of opinion can be solved.
Establish rules of conduct and unambiguous shared standards and common goals. Strengthening professional relationship Teamwork is an integral part of patient safety in OR. There should be clearer job descriptions and well-defined roles based on relevant competency of each specialty.
If professional relationship develops a bond of friendship, it would remove all barriers and helps to cement relationship. Further inter-professional education and training programs that may enhance professional's knowledge and skills should be encouraged.
Confidence training and engaging in support groups for self-esteem enhancement can be beneficial. The problems created by disruptive physicians should be openly discussed, and policies should be developed to deal with them. Institutional planning Establish an institution conflict management program and foster group cohesion where personal and organizational conflicts can be resolved.
Public awareness Highlighting the image and status of anesthesiologists in public by media may go a long way to boost the morale of anesthesiologists and to create awareness about the role of anesthesiologist in surgical outcome. Follow guidelines and adopting training programs Various guidelines available to deal with the common causes of conflict should be followed.
American Society of Anesthesiologists guidelines for the ethical practice of anesthesiology and modern curriculum on ethics[ 31 ] which was formulated to assist the practising anesthesiologist to deal with conflicts related to ethical issues. Anesthesia crises resource management training[ 32 ] which is analogous to crew resource management to improve the patient safety through team coordination and communication.
Interdisciplinary team training programs for health care workers[ 33 ] developed by institute of medicine to decrease the incidence of preventable medical errors. Guidelines for fee structure of an anesthesiologist prepared by the anesthesiologist's society of different countries should be followed in a uniform manner.
Taking time off from work at regular intervals will remove the person from stressful work environment and helps to rejuvenate both physically and psychologically. Persons who regularly take time off work to go on vacations, report significantly higher well-being than their counterparts who are glued to their work year-round.
Operating Room Nurses Knowledge and Practice of Sterile Technique | OMICS International
Taking conflict in a stride and learning the skills to resolve it in ways that increases understanding, builds trust and strengthens relationship will go a long way in creating a professional relationship healthy and strong which is an important component of good patient care.
Focus should be on avoiding the conflict and if it is inevitable, then resolving it. To this direction, specific interventions are needed to aim for cultivating respect and peaceful collaboration between surgeon and anesthesiologist and to foster high standards of patient safety and quality of care. Footnotes Conflict of Interest: Conflict in the care of patients with prolonged stay in the ICU: Types, sources, and predictors.
Conflict and its resolution in the operating room.
Gillespie BM, Kermode S. How do perioperative nurses cope with stress? Safety in the operating theatre — Part 1: Interpersonal relationships and team performance.
Curr Anaesth Crit Care. Anesthesiologist — Surgeon conflicts at workplace: An exploratory single — Center study from Egypt. Ibnosina J Med Biomed Sci.
Managed care and the imperative for a new professional ethic. Health Aff Millwood ; Redefining the preoperative evaluation process and the role of the anesthesiologist. Conflict resolution in healthcare management.
Physician communication in the operating room: Expanding application of face-negotiation theory to the health communication context. Perception about the role of anesthesia and anesthesiologist among the paramedical staffs: Perspective from a medical college in Nepal.
Nature of conflict in the care of pediatric intensive care patients with prolonged stay. Can nurses refuse to carry out doctor's orders? The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay. The contribution of a preoperative evaluation to patient safety in high-risk surgical patients: Discrepant attitudes about teamwork among critical care nurses and physicians.
Questionnaire survey of working relationships between nurses and doctors in University Teaching Hospitals in Southern Nigeria. Implications and strategies for patient and provider safety.