Intraoperative Care of the Conscious Patient from the Perspective of the Operating Theatre Nurse

Intraoperative care is patient care during an operation and ancillary to that operation. Activities such as monitoring the patient’s vital signs, blood oxygenation levels, fluid therapy, medication transfusion, anesthesia, radiography, and retrieving samples for laboratory tests, are examples of intraoperative care. And the intraoperative phase starts when the patient arrives in the operating theatre (OT) and ends when he/she is transferred to the postoperative ward.

Surgery performed under regional or local anaesthesia allows the patient to remain conscious during the procedure and is rather common in Swedish healthcare today. In this study, the authors aimed to obtain a deeper understanding of the main concerns of operating theatre nurses (OTN) when caring for conscious patients during the intraoperative phase. 

The study was carried out in 23 OTNs of five different hospitals in Sweden, selected for convenience because of its location. Data was collected from focus group and individual interviews between September 2016 and March 2017 and analyzed according to grounded theory. 

The results indicated that the main concern among the OTNs was to take the patient in consideration. The core category “achieve and maintain ethical treatment of patients” in the operating theatre (OT) was a strategy used throughout the intraoperative process. Ethical treatment was described as moral behaviour at different levels and included the team’s behaviour, respectful and individualized patientcare, and the working-morale of the professionals. Being vigilant and being flexible were the categories related to the core category. The OTNs constantly assessed where to pay most attention as they balanced between the needs of the patient, the team, and the surgery procedure.

In conclusion, the findings illustrate the importance of a common vision of high ethical standards within a surgical team to ensure that the patient is taken in consideration. This study also reveals how vulnerable ethics can be in an unfamiliar team, both from a technical and non-technical standpoint, and suggests that ethics should be strongly considered, especially when it comes to surgery utilizing local or regional anesthesia. The OTNs concern about considering the conscious patient, and the skills they develop and apply to address this concern, can be added to further describe the professional competencies of OTNs.

Article by Kerstin Brodin, et al, from Mid Sweden University, Sundsvall, Sweden.

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