SURGICAL CONSCIENCE IN THE OR��“Every contamination matters”

Silas Kangogo (BSCN/KRPON)

Lydia Bundotich (MSCN.Medsurg/KRPON)�MTRH-KENYA

Surgical conscience

Definition

• Is the moral obligation to uphold and defend surgical asepsis and perioperative safety no matter the cost or consequence’(ORNAC 2022).

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• It is the behavior of the professional that demonstrates, understands, and fulfills the principles of surgical technology and the legal, ethical and moral responsibilities to all patients and all team members for which each individual practitioner is accountable for.

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Background

• The surgical conscience falls into several domains, including nursing, surgery, anesthesiology, surgical technology and interventional radiology.
• Unfortunately, some surgeons and or staff members can be demanding, rude and even hateful.(AORN 2022).
• Eighty-five percent of the nurses who responded to the survey said they had been in a situation where a safety tool warned them of a problem. However, more than half (58 percent) said they either felt it was unsafe to speak up or they were unable to get others to listen(AORN and AACN 2019).

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Continue………

• Speaking up—even when it’s difficult is the most challenging part of following surgical conscience for many perioperative nurses
• Honesty and integrity in surgical practice environments is a cornerstone to infection prevention and control practices
• It is often described as an inner "voice" reminding you of the correct thing to do in a surgical environment.
• The cost of ignoring a surgical conscience directly affects the patient. A Golden Rule:”Do unto the patient as you would have others do unto you”
• We have a role to play in patient safety and follow best practices.

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Objective

• To ensure safe, ethical, competent surgical patient care leading to optimal patient outcomes, including the prevention of surgical site infections (SSI).

Conceptual Framework

• Surgical Conscience is dependent on the presence of three constructs: consciousness (knowing),

conscience (feeling), and agency (acting) and is moderated by contextual factors such as education,

training, mentorship, environment, culture, and support.

What does this mean?

• Always have your eyes on the sterile field and remember to never turn your back to it.
• MUST admit and acknowledge when you have a break in technique and feel free to speak up and point it out (not being afraid to speak up)
• Circulating nurse’s role in the OR is to say stop and say that something isn’t right. Any time anything in surgery – not just sterile technique is not right, you must be able to speak your mind.
• The OR is not the time or proper place to keep quiet and tell somebody about it afterwards.
• You may see something that someone else on the team did not.
• You may see something that is the difference between life and death and you must know when and how to say what has happened.
• A nurse has to stand for what is right all the time to protect the patient.

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Barriers to the practice of surgical conscience

• Acting upon one’s surgical conscience may not always be well-received by perioperative colleagues.
• Requiring nurses to make difficult decisions under pressure and acts of surgical conscience may often cause delays.
• Stress at work place
• Education level.
• Nurses may not feel empowered to demonstrate their moral courage and speak up due to; Perceived hierarchy in the OR, facility’s culture, navigating challenging personalities, fear of retribution. 

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• The external forces and powers that control health care practices .(insurance companies and legislative requirements).
• Unconducive working environment.
• Knowledge and Attitude.
• Insufficient materials to work with.
• working with difficult surgeons and time factor.
• Also the factors that can make a practitioner refuse to admit committing errors, such as high rank of the officer, too simple error and so on.

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Consequences of not practicing surgical conscience

• If you want to know why a patient has a surgical site infection, look no further than the time a nurse couldn’t vocalize that something got contaminated.(Danielle Quintana 2019).
• Post-operative infections that can lead to long hospital.
• Increased cost of treatment.
• Litigations

Actions to be taken to ensure adherence

• You MUST admit and acknowledge when you have a break in technique.
• Circulating nurse’s role in the OR is to say stop and say that something isn’t right.
• Use their knowledge of sterile technique, attentively avoid and recognize breaks in technique, and immediately begin to mitigate breaks in technique when they occur.
• Enhance teamwork.
• Establish policies, standards and best practices recommendations that dictate proper procedures for every or activity.
• Exhibiting ethical behavior.
• Promoting patient safety all the time, in every circumstance. Stand for what is right all the time to protect the patient.

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• Take responsibility.
• Adherence to surgical timeout.
• Education all team members.
• leading by example.
• Uphold the highest nursing values.
• Staff empowerment.
• Favorable working conditions.
• Positive departmental culture.

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Conclusion

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• Regardless of the challenge presented, surgical conscience encompasses the belief that health care professionals have a responsibility to patients and to themselves to be consistent, accurate and safe.
• SSSSSSSS This duty or obligation should be performed with the highest level of commitment.

END�“We take pride in our�work and we want the best possible outcomes for our patients”.

References

AORN (2022)Surgical Conscience: A Concept Analysis for Perioperative Nurses

ORNAC (2022) Surgical conscience and its role in patient safety and care

Duff et al (2022) What does surgical conscience mean to perioperative nurses: An interpretive description

Kolawole I. O and Ilesanm R .E(2018) Knowledge and Attitude of Nurses on the Practice of Surgical Conscience in Surgical Management of Patients

Laurieb Fickman (2022) Examining Moral Courage in the Operating Room. “Surgical Conscience Among Perioperative Nurses”

Margaret H M & Roth Rock JC (2022). Alexander’s care of patient in surgery (17^th edition) St. Louis Mosby.