The aim of this study was to illuminate operating room nurses' skills in managing unexpected events in the operating room.
Background:
Operating room nurses are working in a high-tech, high-risk environment where unexpected events are common. Operating room nurses are responsible for acting fast and correctly on these occasions; in order to sustain patients' safety, prevent major complications and secure a successful outcome.
Method:
Four focus group interviews with 23 operating room nurses working in two Norwegian hospitals were conducted. A method of systematic text condensation developed by Malterud was used to analyze the data.
Findings:
The main theme that emerged in the interpretation of the interviews was: being prepared for the unexpected. Four sub- themes were identified: being in control, flexibility and improvisation, teamwork and professional confidence.
Conclusion:
Operating room nurses tried to be prepared to manage all kinds of unexpected events in the operating room. Comprehensive knowledge and experience, technical-, cognitive- and social skills enabled operating room nurses to manage these events, which increased their personal and professional confidence.
GawandeA. The checklist manifesto: How to get things right. London: Profile books; 2010.
3.
GawandeAAThomasEJZinnerMJBrennanTA. The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery. 1999; 126(1): 66–75.
4.
HaynesABWeiserTGBerryWRLipsitzSRBreizatA-HSDellingerEP. A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine. 2009; 360(5): 491–9.
5.
GawandeAAStuddertDMOravEJBrennanTAZinnerMJ. Risk Factors for Retained Instruments and Sponges after Surgery. New England Journal of Medicine. 2003; 348(3): 229–35.
6.
SteelmanVMCullenJJ. Designing a Safer Process to Prevent Retained Surgical Sponges: A Healthcare Failure Mode and Effect Analysis. AORN Journal. 2011; 94(2): 132–41.
7.
MelbyLToussaintPJ. Coping with the unforeseen in surgical work. International Journal of Medical Informatics. 2011; 80(8): 39–47.
8.
HøylandSAaseKHollundJG. Exploring varieties of knowledge in safe work practices — an ethnographic study of surgical teams. Patient Safety in Surgery. 2011; 5: 21.
9.
KingdonBHalvorsenF. Perioperative nurses' perceptions of stress in the workplace. AORN Journal. 2006; 84(4): 607–614.
10.
AlfredsdottirHBjornsdottirK. Nursing and patient safety in the operating room. Journal of Advanced Nursing. 2008; 61(1): 29–37.
11.
BerlandA. Ivaretakelse av pasientsikkerhet. Vård i Norden. 2005; 25(3): 33–8.
12.
BerlandANatvigGKGundersenD. Patient safety and job-related stress: A focus group study. Intensive and Critical Care Nursing. 2008; 24(2): 90–7.
13.
BennerPMallochKSheetsVBitzK. Nursing pathways for patient safety. St. Louis, Mo.: Mosby Elsevier; 2010.
14.
GillespieBMChaboyerWWallisMChangHAWerderH. Operating theatre nurses' perceptions of competence: A focus group study. Journal of Advanced Nursing. 2009; 65(5): 1019–28.
KruegerRACaseyMA. Focus groups: A practical guide for applied research. Los Angeles, Calif.: Sage; 2009.
17.
McLaffertyI. Focus group interviews as a data collecting strategy. Journal of Advanced Nursing. 2004; 48(2): 187–94.
18.
MalterudK. Kvalitative metoder i medisinsk forskning: En innføring. Oslo: Universitetsforlaget; 2011.
19.
ThagaardT. Systematikk og innlevelse: En innføring i kvalitativ metode. Bergen: Fagbokforl.; 2009.
20.
GlaserBGStraussAL. The discovery of grounded theory: Strategies for qualitative research. New York: Aldine de Gruyter; 1967.
21.
GiorgiA. The similarities and differences between descriptive and interpretative methods in scientific phenomenological psychology. In: GuptaB, editor. The Empirical and the transcendental: A fusion of horizons. Lanham Md: Rowman & Littlefield; 2000. p. 61–75.
22.
GraneheimUHLundmanB. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2003; 24(2): 105–12.
23.
BennerPHooper-KyriakidisPStannardD. Clinical wisdom and interventions in acute and critical care: A thinking-in-action approach. New York: Springer Publ.; 2011.
24.
BondSCooperS. Modelling emergency decisions: Recognition-primed decision making. The literature in relation to an ophthalmic critical incident. Journal of Clinical Nursing. 2006; 15(8): 1023–32.
25.
TurnbullJ. Intuition in nursing relationships: The result of ‘skills’ or ‘qualities’?Br J Nursing. 1999; 8(5): 302–6.
26.
BillayDMyrickFLuhangaFYongeO. A pragmatic view of intuitive knowledge in nursing practice. Nursing Forum. 2007; 42(3): 147–55.
27.
TannerJ. Advanced practitioners within the operating theatre. British Journal of Perioperative Nursing. 2003; 13(12): 514–8.
28.
MitchellLFlinR. Non-technical skills of the operating theatre scrub nurse: Literature review. Journal of Advanced Nursing. 2008; 63(1): 15–24.
29.
RileyRGManiasE. Governance in operating room nursing: Nurses' knowledge of individual surgeons. Social Science & Medicine. 2006; 62(6): 1541–51.
30.
MitchellLFlinRYuleSMitchellJCouttsKYoungsonG. Thinking ahead of the surgeon. An interview study to identify scrub nurses' non-technical skills. International Journal of Nursing Studies. 2011; 48(7): 818–28.
31.
ElferingASemmerNKGrebnerS. Work stress and patient safety: Observer -rated work stressors as predictors of characteristics ofsafety — related events reported by young nurses. Ergonomics. 2006; 49(5–6): 457–69.
32.
LeachLSMyrtleRCWeaverFADasuS. Assessing the performance of surgical teams. Health Care Management Review January/March. 2009; 34(1): 29–41.
33.
Silen-LipponenMTossavainenKTurunenHSmithA. Potential errors and their prevention in operating room teamwork as experienced by Finnish, British and American nurses. International Journal of Nursing Practice. 2005; 11(1): 21–32.
34.
MartinAGrayCAdamA. Nurses' responses to workplace verbal abuse: A scenario study of the impact of situational and individual factor research and practice in human resource management. 2007; 15(2): 41–61.
35.
FlinRHMitchellL. Safer surgery: Analysing behaviour in the operating theatre. Burlington, VT: Ashgate Pub.; 2009.
