Silence, power and communication in the operating room

Abstract

Title. Silence, power and communication in the operating roomAimThis paper is a report of a study conducted to explore whether a 1- to 3-minute preoperative interprofessional team briefing with a structured checklist was an effective way to support communication in the operating room.BackgroundPrevious research suggests that nurses often feel constrained in their ability to communicate with physicians. Previous research on silence and power suggests that silence is not only a reflection of powerlessness or passivity, and that silence and speech are not opposites, but closely interrelated.MethodsWe conducted a retrospective study of silences observed in communication between nurses and surgeons in a multi-site observational study of interprofessional communication in the operating room. Over 700 surgical procedures were observed from 2005–2007. Instances of communication characterized by unresolved or unarticulated issues were identified in field notes and analysed from a critical ethnography perspective.FindingsWe identified three forms of recurring ‘silences’: absence of communication; not responding to queries or requests; and speaking quietly. These silences may be defensive or strategic, and they may be influenced by larger institutional and structural power dynamics as well as by the immediate situational context.ConclusionsThere is no single answer to the question of why ‘nobody said anything’. Exploring silences in relation to power suggests that there are multiple and complex ways that constrained communication is produced in the operating room, which are essential to understand in order to improve interprofessional communication and collaboration.

Respecting as a basic teamwork process in the operating theatre - A qualitative study of theatre nurses who work in interdisciplinary surgical teams of what they see as important factors in this collaboration

“…The theatre nurses may be reluctant to speak up about safety concerns and patient safety may be negatively affected (1). The hierarchy threatened safety because less powerful members had limited input in decision making, and were reluctant to speak up (15,33,39). In our study the theatre nurses feel they lose their concentration and focus when communication is not respectful in the team.…”

Nurse–Physician Collaboration in General Internal Medicine: A Synthesis of Survey and Ethnographic Techniques

“…This may be related to physicians' tendencies to de-emphasize relational aspects of patient care in favour of 'case knowledge' which emphasizes medical diagnostic and treatment-of-disease approaches (SteinParbury & Liaschenko, 2007). In the operating room, observational research showed how nurses use a variety of communication strategies, including not communicating at all, to negotiate constraints on their role autonomy in relation to physicians' (Gardezi et al, 2009). Observations of nurses' disengagement from collaborative practice have found that physicians neglect to incorporate the core values of nursing practice into interprofessional care, thus impacting nurses' willingness to collaborate (Miller et al, 2008).…”

Quantitative work demands, emotional demands, and cognitive stress symptoms in surgery nurses

“…Moreover, surgical nurses have intense emotional demands, including feeling responsible for keeping peace during surgery by 'knowing the surgeon's soul' (Riley & Manias, 2006, p. 1548. They find it difficult to speak up when procedures (might) go wrong (Gardezi et al, 2009) and they experience inner conflicts about how to react adequately to 'emotional abuse' including being 'belittled, ridiculed, yelled and sworn at' (Higgins & MacIntosh, 2010, p. 322). Feeling responsible for keeping peace and experiencing verbal insults is stressful and can lead to cognitive stress symptoms such as impaired allocation of attention to the task (Pereira, Müller, & Elfering, 2015).…”