Managing complexity in the operating room: a group interview study

Göras, Camilla; Nilsson, Ulrica; Ekstedt, Mathias; Unbeck, Maria; Ehrenberg, Anna

doi:10.1186/s12913-020-05192-8

Cited by 46 publications

(50 citation statements)

References 35 publications

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“…When combining these different aspects of practice, a picture of a complex and dynamic work process is revealed. Previous research regarding RNAs' work has focused on areas such as non-technical skills, 44 45 experiences from different clinical aspects of work, [46][47][48][49] patient advocacy 50 51 and work experiences. 52 This study builds on this knowledge by illuminating how RNAs' work is actually done, uniquely mapping the different dimensions of work in relation to the intraoperative work process and thus providing further insights into the context and challenges for safe practice.…”

Section: Discussionmentioning

confidence: 99%

“…This may contribute to creating safe care through increased readiness to respond to both expected and unexpected events during intraoperative anaesthesia care. 47 If no nursing student was present and supervision was not required, the preoperative preparation was mainly performed independently, which could explain the rarity of multitasking.…”

Section: Open Accessmentioning

confidence: 99%

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Mapping registered nurse anaesthetists’ intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study

et al. 2022

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IntroductionSafe anaesthesia care is a fundamental part of healthcare. In a previous study, registered nurse anaesthetists (RNAs) had the highest task frequency, with the largest amount of multitasking and interruptions among all professionals working in a surgical team. There is a lack of knowledge on how these factors are distributed during the intraoperative anaesthesia care process, and what implications they might have on safety and quality of care.ObjectiveTo map the RNAs’ work as done in practice, including tasks, multitasking, interruptions and their causes, and interactions, during all phases of the intraoperative anaesthesia work process.MethodsStructured observations of RNAs (n=8) conducted during 30 procedures lasting a total of 73 hours in an operating department at a county hospital in Sweden, using the Work Observation Method By Activity Timing tool.ResultsHigh task intensity and multitasking were revealed during preparation for anaesthesia induction (79 tasks/hour, 61.9% of task time spent multitasking), anaesthesia induction (98 tasks/hour, 50.7%) and preparation for anaesthesia maintenance (86 tasks/hour, 80.2%). Frequent interruptions took place during preoperative preparation (4.7 /hour), anaesthesia induction (6.2 /hour) and preparation for anaesthesia maintenance (4.3 /hour). The interruptions were most often related to medication care (n=54, 19.8%), equipment issues (n=40, 14.7%) or the procedure itself (n=39, 14.3%). RNAs’ work was conducted mostly independently (58.4%), but RNAs interacted with multiple professionals in and outside the operating room during anaesthesia.ConclusionThe tasks, multitasking, interruptions and their causes, and interactions during different phases illustrated the RNAs’ work as done, as part of a complex adaptive system. Management of safety in the most intense phases—preparing for anaesthesia induction, induction and preparing for anaesthesia maintenance—should be investigated further. The complexity and adaptivity of the nature of RNAs’ work should be taken into consideration in future management, development, research and education.

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Section: Discussionmentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

Mapping registered nurse anaesthetists’ intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study

et al. 2022

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“…This complexity entails that the personnel needs to be flexible and creative to manage the unpredictable events that may occur, i.e. an ability of resilience for patient safety ( 11 ). To our knowledge, this resilience among the OR personnel has not been previously studied during the pandemic, even though this group often were relocated to care for COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

Moral Distress Among Operating Room Personnel During the COVID-19 Pandemic: A Qualitative Study

Fagerdahl

Torbjörnsson

Gustavsson

et al. 2022

Journal of Surgical Research

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Background The ongoing COVID-19 pandemic has necessitated the reallocation of healthcare resources, and a minimization of elective activities. Healthcare personnel involved in COVID-19 care have been found to be negatively affected by the associated excess stress. The existing COVID-19 research has focused on the experiences among healthcare personnel in general, and not particularly on the operating room members, who have often been relocated to overburdened workplaces. Therefore, we aimed at exploring the experiences in this particular group. Methods This study has a qualitative inductive design based on interviews with a strategic sample of 12 operating room members: surgeons, anesthesiologist, specialist nurses and nurse assistants. The interviews were analysed using content analysis. Results Three themes were identified; “Feeling safe in the familiar and anxiety in the unknown”, “To be the ones left behind”, and “The possibility for recuperation in a seemingly everlasting situation”. The participants described working hard, although it was experienced as not enough according to their moral ideals. We interpreted this as feelings and signs of moral distress, a commonly described concept in previous studies during the COVID-19 pandemic, and a risk for burn out. Conclusions The operating room members emphasized the negative stress of being in the unknown, of performing work tasks in an unfamiliar place and situation, and of experiencing conflicting feelings of relief and guilt. Organizational strategies towards a functional leadership and support should be emphasized. Such strategies might reduce the risk of psychological consequences such as burn out.

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“…46 This is in line with another report that suggests that to manage the complexity in OR and maintain safe care necessitates the ability to respond to both the expected and the unexpected. 39 Our findings show that resilience exists within the organisations, but it is not only used in unpredictable situations. The ORNs demonstrated resilience in managing the everyday work.…”

Section: Discussionmentioning

confidence: 66%

“…38 Safety controls, such as checklists, were identified as crucial for preserving safety during surgery, as presented in an earlier report. 39 Control steps were seen as guidance for safe practice, and specifically SSC as a useful tool to maintain a high level of safety awareness. In other reported findings SSC was noted to increase communication and teamwork in OR 40 41 and to recognise potential risks.…”

Section: Discussionmentioning

confidence: 99%

Patient safety during joint replacement surgery: experiences of operating room nurses

et al. 2021

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BackgroundAvoidable complications for surgical patients still occur despite efforts to improve patient safety processes in operating rooms. Analysis of experiences of operating room nurses can contribute to better understanding of perioperative processes and flow, and why avoidable complications still occur.AimTo explore aspects of patient safety practice during joint replacement surgery through assessment of operating room nurse experiences.MethodA qualitative design using semistructured interviews with 21 operating room nurses currently involved in joint replacement surgery in Sweden. Inductive qualitative content analysis was used.ResultsThe operating room nurses described experiences with patient safety hazards on an organisational, team and individual level. Uncertainties concerning a reliable plan for the procedure and functional reporting, as well as documentation practices, were identified as important. Teamwork and collaboration were described as crucial at the team level, including being respected as valuable, having shared goals and common expectations. On the individual level, professional knowledge, skills and experience were needed to make corrective steps.ConclusionThe conditions to support patient safety, or limit complication risk, during joint replacement surgery continue to be at times inconsistent, and require steady performance attention. Operating room nurses make adjustments to help solve problems as they arise, where there are obvious risks for patient complications. The organisational patient safety management process still seems to allow deviation from established practice standards at times, and relies on individual-based corrective measures at the ‘bedside’ at times for good results.

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Managing complexity in the operating room: a group interview study

Cited by 46 publications

References 35 publications

Mapping registered nurse anaesthetists’ intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study

Mapping registered nurse anaesthetists’ intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study

Moral Distress Among Operating Room Personnel During the COVID-19 Pandemic: A Qualitative Study

Patient safety during joint replacement surgery: experiences of operating room nurses

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