Teamwork and Collaboration in Perioperative Nursing and how it Effects Patient Safety

Teamwork is the combined efforts of a group of people in order to reach a common goal. Collaboration is the action of working together to produce a satisfying outcome. The combination of the two concepts cumulates an ideal perioperative environment. In perioperative nursing the teamwork and collaboration between the circulating nurse and scrub nurse is an important dynamic relationship in the operating room. The roles of the circulating and scrub nurse are key factors that contribute to the success of operations.

Teamwork and collaboration in the perioperative field are valuable tools that should be used in the operating room in order to provide the best and safe care of patients.

Description of Capstone Experience

During my time at capstone I observed how perioperative teams were able to collaborate and work harmoniously together. I was able to sit in on a robotic surgery where the patient was having an omentectomy and hysterectomy. The surgery was in close proximity of an artery. The surgeon and fellow were trying to avoid the artery of course. As the surgery was progressing an unknown location was bleeding. At this moment the operating room became very tense. The surgeon was unsure if they snipped the artery. Everyone was able to communicate calmly about what was occurring.

The surgeon was communicating with the fellow and physician assistant about the bleed. The circulating and scrub nurse listened and asked what the next step or plan was to stop the bleed because then the circulating and scrub nurse would be able to anticipate what would be needed in order for success to be obtained. The surgeon communicated to circulating nurse that she may open the patient but she wanted to try to resolve it through the robotic surgery.

This vital information provided by the surgeon helped the circulating nurse to anticipate what would be needed if the doctor decided to open the patient. The circulating nurse explained to me that she was going to request the needed instruments and supplies needed for an open surgery. The surgeon tried to resolve the bleed through robotics but was unable to so she decided to discontinue the robotic surgery and open the patient up in order to get a clearer view of what was occurring.

The surgeon communicated the change to everyone in the operating room. Since the surgeon openly communicated that she may open the patient, the perioperative team was prepared for the change. The operating room was not chaotic because the circulating nurse was able to retrieve the right instruments and supplies needed for an open surgery prior to the surgeon's decision. The scrub nurse was able to prep the sterile instruments and prepare his table while the surgeon scrubbed in for surgery.

The circulating nurse was able to safely reposition the patient on the table for the surgery while the certified nurse anesthesiologist kept the patient stable. The open communication and interprofessional relationships between the team members in the operating room helped to facilitate a smooth transition from an unexpected change in surgeries. The open communication in the operating room helped to maintain the delivery of safe high-quality care to the patient.

Literature Review

The operating room has long been viewed as a place where the surgeon is the focus and his/her needs must be met in order for a surgery to be successful. Although the dynamic of the operating room may have functioned in a surgeon focused manner years ago, times have changed. In today's operating room the main focus of every team member is the patient. According to an article named Perceptions of Teamwork in the OR: Roles and Expectations, ""Traditionally, the physician-surgeon has given orders and dictated the pace, an approach that has not always proved to be ideal"" (Grady 24).

Physician led operating rooms have not always proved to be the best strategy for successful surgeries and safe patient care. Everyone in the operating room must work together for one common goal which is to deliver the best possible care to the patient. Teamwork in the operating room is what contributes to the success of procedures and to patient safety. In the article, the author describes a survey that was distributed to all operating staff in Catholic health systems in 16 states. The survey was made to view how operating staff members rated each other on communication and collaboration. Surgeons rated their discipline as the highest for teamwork while their colleagues rated their teamwork as the lowest amongst the group. Operating room nurses were rated the highest marks for teamwork by their colleagues (Grady 25).

Nurses in the operating room are the main facilitators of teamwork in the operating room. The circulating nurses are the managers of the room. They ensure that the instruments and supplies are delivered to the operating room and that the machines are working accordingly. The circulating nurse verifies that the consent has been signed and the patient is aware of the surgery being performed. The circulating nurse also ensures that the operating team has the right patient for the right surgery and that the patient is safe to perform surgery on.

The circulating nurse also documents what is occurring during surgery. The circulating nurse makes certain that all of the pertinent patient information is communicated to the team in the operating rooms. The scrub nurse verifies that all the instruments and supplies are in the room and listens to what instruments the surgeon needs while the surgery is being performed. The nurses in the operating room must listen and observe to what is being done during surgery so that they can communicate to the team what is needed and anticipate the next steps. Perioperative nurses are the core of teamwork and collaboration.

The teamwork and collaboration between the circulating nurse and scrub nurse helps the surgical team to perform their jobs efficiently. Additionally, the operating room team must all collaborate and work together harmoniously. Without the whole team collaborating together surgeries would have a high risk to patients' safety. The dynamics between the nurses and all other team members in the operating room is vital to the success of the surgery and most importantly to the patient.

The pressures on the operative team of operating room turnover times, surgery success, and efficient patient care places a large amount of stress on the perioperative team. Collaboration between the surgical technologists, nurses, surgeons, anesthesiologists, and supportive staff is essential in the perioperative setting. According to L. Suzanne Sterchi, ""Collaboration is vital if these competing demands are to be incorporated into safe high-quality surgical care"" ( ). Collaboration between the nurses and the other perioperative team members is one of the most important contributing factors to patient safety in the operating room.

Respect between each perioperative team member is essential in forming qualitative teamwork and collaboration. In Sterchi's research she referenced a study by Espin and Lingard. The study showed the importance of collaboration in the perioperative area of healthcare. Espin and Lingard observed in their study that many of the errors during surgical procedures were as a result of poor-quality interprofessional relationships in the perioperative setting ( ).

Each team member must respect and understand each person's role in the operating room. In the perioperative setting no role is too small. Each team member is an important component to the surgical team and to the success of surgeries. Successful interprofessional relationships in the perioperative field are the foundation of teamwork and collaboration. Operative team members must have healthy professional relationships in order to achieve high-quality teamwork and collaboration, and most importantly to facilitate patient safety for every patient that steps into the operating room.

Open communication is a significant factor that contributes to successful teamwork and collaboration in the perioperative setting. According to a study titled Safe Surgery Checklist, Patient Safety, Teamwork, and Responsibility-Coequal Demands? A Focus Group Study (Willassen, Jacobsen, & Treiten), the participants of the study discussed the importance of open communication between all team members and how open communication contributed to patients' outcome. The discussion revealed that mutual respect was a factor that contributed to open communication.

Mutual respect of colleagues leads to each individual performing to the best of their abilities which then leads to the team performing well as a whole. Respecting each other helps to give nurses in the operating room the confidence to have open communication. Additionally, open communication gives nurses the ability to advocate for patients in the operating room without feeling like he/she would be ignored or chastised. Nurses must always advocate for patients no matter the situation so that patients can receive the best and safest care.

Open communication eases the tension in the operating room and makes it easier for nurses to perform their job. According to Grady, ""In 1998, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) identified 'breakdowns in communication as the leading root cause of wrong-site operations, and other sentinel events"" ( ). Patients' safety is at risk if there is a lack of open communication in the operating room. Therefore open communication should be implemented in every operating room for the greater good of the patient.

The literatures focused on teamwork and collaboration in the perioperative area of healthcare. Each literature focused on teamwork and collaboration and its effects on patient care and safety. The literatures placed emphasis on the criticality of teamwork and collaboration and how these components are facilitated by perioperative teams.

The Future Studies

Future studies should focus on the improvement of teamwork and collaboration in the perioperative field. ""Collaboration saves lives....Collaboration, therefore, needs to be a recognized institutional goal"" (Sterchi 55). Collaboration between operating team members is one of the most important factors that contributes to high-quality surgical care and patient safety. Since nurses are the core of teamwork and collaboration, nurses should take the lead in facilitating teamwork and collaboration in operating rooms.

According to Sterchi, ""Nurse administrators can play a key role in the development and support of this initiative...Medical and nursing leaders should model collaborative behavior and teamwork in their day-to-day interactions (Sterchi 55). The leaders of the perioperative department such as nurse leaders, medical leaders, and anesthesiology leaders should emulate teamwork and collaboration in order to influence behaviors in the operating rooms. Another way to influence improvements in teamwork and collaboration is for the perioperative departments to provide in-service programs and workshops to the operating room staff.

Providing such resources can help educate the perioperative team members on how to improve their communication. Also, these types of programs can emphasize the importance and influence that teamwork and collaboration in the operating room has on patient outcomes and safety. An additional resource that can help facilitate teamwork and collaboration in the operating room would be to provide cross-disciplinary shadowing for doctors and nurses (Sterchi).

Sterchi states that cross-disciplinary shadowing ""can help to improve mutual understanding of roles and enable both groups to better envision collaborative practice"" (Sterchi 56). Having nurses and surgeons shadow each other will enable each one to understand the roles that each one has in the operating room. With this understanding, each can learn how to communicate successfully so that the goal of providing high-quality and safe care to patients can be achieved.

Conclusion

In conclusion, teamwork and collaboration in perioperative nursing is a critical component in delivering high-quality care and patient safety. Each member of the perioperative team including surgeons, nurses, anesthesiologists, and supportive staff must communicate clearly and work cohesively together in order to reach the same end goal—safe and successful surgeries. All perioperative healthcare professionals are responsible for each patient that enters the operating room.

Teamwork and collaboration between every professional in the perioperative setting is essential because without those critical components, patient safety would be at risk. Perioperative nursing is exceptionally distinct from other areas of nursing. However, in the end perioperative nurses remain focused on patient-centered care and patient safety through facilitating teamwork and collaboration.

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