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Perioperative people skills

Nurses in the operating room should be conduits for communication and teamwork to help prevent errors, educators say.

Education providers, including the Australian College of Nursing (ACN) and universities throughout the nation, are putting greater focus on non-technical skills in curriculums for perioperative nurses.

Communication, teamwork and coordination skills are among the factors seen as essential to enhancing surgical outcomes and building a safety culture in the operating room – one of the most risk-laden, error-prone areas in any hospital.

Dr Brigid Gillespie, senior research fellow at Griffith University, specialises in operating room nursing, and has a particular interest in teamwork and communication in surgery.

Gillespie co-authored the report Team communication in surgery – creating a culture of safety, which was published online in May this year and suggests that the complexities that arise in healthcare are not necessarily linked to the number of providers – rather the interdependencies of professionals that provide that care.

Main members of a surgical team – surgeons, anesthetists and nurses – are highly trained and skilled professionals with the ability to perform at extraordinarily high standards; however, as the report’s findings suggest, they are not purposely trained to apply these skills in a team environment and often have different perspectives about work roles and risks.

To combat this, nurses need to act as the conduit – the link between all professionals – in order to improve safety and quality within the operating room.

Gillespie says perioperative nurses need to be able to promote an environment of effective communication – one where people are willing to communicate and discuss potential risks.

“The nurse is often the person who holds it all together,” she says. “We have always prided ourselves on our technical skills, but we are not technicians. It is more important to be a good communicator and a good team player, to open and create an atmosphere where people feel they can speak up if they need to.”

Gillespie is conducting research into the ways hospitals are using the WHO surgical safety checklist – a tool that was placed in operating rooms to open communication.

So far, her research has found this tool is not being used as intended; she has received grants to explore the problem.

Emma Woodhouse, course coordinator perioperative nursing at ACN, says many healthcare workers see the WHO checklist as just another piece of paper to complete.

“Many workplaces will be discussing the implementation of the WHO checklist without appreciating the studies of human factors,” Woodhouse says. “I think many workplaces would benefit from seeing this evidence behind their practice. If they can view it as a pathway to reducing never-ever events, quality and patient safety can be improved.”

She also highlights the importance of developing situational awareness, saying novice nurses need to keep their eyes and ears open for other activities happening around them – the first step in speeding up acquisition of this important skill.

Clinicians with a developed sense of situational awareness can focus on the task at hand whilst having an ear or an eye open for other activities or a change in tone of voice from the surgeon that may signal something is wrong, Woodhouse says, such as unexpected bleeding.

This sense of situational awareness can initiate an immediate effective response, such as opening more sponges, connecting another sucker or starting a blood transfusion.

Without this sense, nurses will take longer to react or may wait for a prompt to initiate an action, which can lead to a patient’s condition being compromised.

This was the case for Martin Bromiley’s wife, who died as a result of medical errors during routine surgery. In a heartbreaking YouTube clip, Bromiley retells the events leading up to his wife’s death. An independent review found later that a well-equipped operating theatre and a team of clinicians had failed to respond appropriately to an unanticipated emergency.

Bromiley, an airline pilot, knew that in aviation, 75 per cent of all accidents could be attributed to communication breakdowns or human factors – he thought this held vital lessons for the healthcare industry.

Believing that it wasn’t the clinicians who had failed, “rather that the system and training had failed them”, he founded the Clinical Human Factors Group in 2007 to promote understanding of human factors in healthcare “from board to ward and beyond”.

Woodhouse says, “The poignancy of Bromiley’s story is something every nurse can apply to practice. There are many occasions when you hear, ‘I would have done things differently’”.

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