Undergoing surgery: the operating theatre experience

8 Undergoing surgery


the operating theatre experience



Chapter aims




•  To develop an awareness of the operating theatre environment


•  To understand the key principles of practice in the operating theatre


•  To gain an insight into the patient’s experience in the operating theatre


•  To identify key learning needs to achieve in the operating theatre



Introduction


In this chapter, we explain the basic principles of the operating theatre environment, the personnel who you will come across in the theatre during your placement learning experience and the broad principles of theatre practice and key health and safety considerations for both patients and theatre personnel. General principles of being a student in this environment are also explored. It is beyond the scope of this book to give full details of all aspects of caring for a patient in the operating theatre, and further reading material is provided at the end of the chapter for you to explore various aspects of what you might learn about in this placement.



Entering the operating theatre


The patient enters the theatre in the care of the anaesthetist and assistants, who will be responsible for their safety and wellbeing together with the rest of the surgical team until the end of the surgery and during the patient’s time in the postoperative recovery room. We return to safety issues in the operating theatre later in the chapter; however, consider the following activity before your placement.



image Activity


The World Health Organisation (WHO) has developed a number of resources to improve surgical patient safety worldwide


Take the time to explore this website:http://www.who.int/features/factfiles/safe_surgery/en/ (accessed December 2011).


Remember that when a patient has a general anaesthetic, it is important to maintain their dignity and respect and to maintain communication in some form throughout the stages of anaesthesia until they are in a sterile field, when touching them on the hand, for example, will no longer be possible. Of course, if they are having a regional anaesthetic where they will be awake during the surgery, then communication goes to the top of the list of importance in the care of the patient. Effective and caring communication is a fundamental part of nursing care and is one of the major domains in the NMC (2010) Standards and Competencies that you have to achieve to qualify as a nurse. In the new curricula, these will be found in your practice assessment documentation which you will take with you to all placements, given that your ongoing record of achievement (ORA) will be required from placement to placement (see further information on Domain 2 at http://standards.nmc-uk.org/PublishedDocuments/Standards%20for%20pre-registration%20nursing%20education%2016082010.pdf (accessed May 2011).



What does the operating theatre look like?


Television series such as Holby City and Gray’s Anatomy have varying degrees of authenticity about their scenarios and context, some more dramatic than others. For most of us, that is as far as we get in terms of a visit to the operating theatre as a patient, but it is important to understand that for many of the patients in your care, this is their first experience.


Explanation of what will happen to patients when they get into the anaesthetic room and the operating theatre is an important part of reducing preoperative anxiety and if, as a student, you have this opportunity to have an ‘insider’ experience then you will be in a more informed position to help patients in your care.


The best way for you to see what the operating theatre looks like before your placement is to look at a visual presentation. You will see that it is a very ‘high tech’ area and many students experience the operating theatre, recovery ward and anaesthetic room during a critical care placement as well as a surgical placement.




image Activity


Discuss with your personal tutor your learning goals with regards to communication in this placement, either on the surgical ward or in the operating theatre. When you arrive on placement, discuss with your mentor what communication competencies you have to achieve in the placement, especially important at the various progression points to the next stage of your programme and journey to become a qualified nurse.


Operating theatres in hospital are normally in a purpose-built unit set apart from the main corridors but within access of surgical wards and recovery areas. There are special safety and infection control requirements essential for an operating theatre which you will experience when you visit or have a placement there. Operating theatres usually come in groups together known as the operating theatre suite – the larger the hospital, the more of these they need to accommodate the various surgeries that need to take place. They can also be attached to day surgery units and even in the community setting, in community hospitals for example.



image Activity


Consider the scenes in this video clip (which has been evaluated for its overall quality in informing you about the perioperative environment and nursing):



http://www.youtube.com/watch?v=exAQC9Ync-0 (accessed December 2011).


What does it tell you about this important and key role for nurses?


Imagine what you think it will look like and what you think you will feel in actually being in the operating theatre. When you have actually experienced it, reflect on your experience using a reflective model/framework and compare your pre-visit notes. This is an excellent reflection to write up for your learning portfolio.


Operating theatres can also be found in isolated places and war zones – the environment being a large tent rather than solid walls. Similar equipment will be found but the surgical team will have to adapt their practice accordingly.



image Activity


View some of the video clips in this chapter from the viewpoint of the general operating theatre environment to gain a pre-placement idea of what to expect.


Before considering the surgical experience for the patient in the operating theatre, we can briefly consider the team members and their roles. You already met some of them in Chapter 7.



The team in the operating theatre


The operating theatre is a highly specialised, multidisciplinary work environment. Operating theatre teams consist of professionals from at least four different specialties, namely anaesthetists, nurses, operating department practitioners and surgeons.


Anaesthetists are specialist doctors who are trained in anaesthesia (refer to Ch. 7).


Surgeons are doctors who have trained in a specific field of surgery following initial qualification and mandatory experience. Examples are orthopaedics, plastic surgery, gynaecology and cardiac surgery.


Scrub nurses are nurses who work directly with one or more surgeons while they are operating on the patient. Sometimes they are called instrument nurses or practitioners (Mitchell & Finn 2008).


Another similar role is the first assistant nurse, who has gained additional qualifications as well as experience in assisting the surgeon during surgery, and undertakes a high level of technical and assistant skills but does not actually carry out the surgery.


A circulating nurse is another type of operating theatre nurse who works on the perimeter of the operating room, monitoring patient care, ensuring that the room stays sterile and keeping track of instruments and sponges. The circulating nurse is a vital team member. This role in the USA is referred to as the circulator nurse.


The AORN Journal website describes the roles of the scrub nurse and the circulator nurse: http://www.aorn.org/CareerCenter/CareerDevelopment/RoleOfThePerioperativeNurse/ (accessed June 2011). You can see where the concept of ‘scrub’ comes from in relation to being ‘scrubbed’ and sterile for working in a sterile field alongside the surgeon.


Operating department practitioners participate as part of the team in a number of roles including the scrubbed role, circulating role and, as is mostly the case in the UK, act as the ‘anaesthetic assistant’ to the anaesthetist. Watch this YouTube clip for more information: http://www.youtube.com/watch?v=buKBoyt6WQs&feature=related (accessed December 2011).



The surgery


We have mentioned a number of different types of surgery, in particular day surgery and surgery requiring a longer hospital stay which could entail minimal invasive surgery or major surgery. It is beyond the scope of this book to cover all these in any detail but further reading is recommended on all of them. When you get to your main placement in perioperative care, it is up to you to find out more about the kinds of surgery that takes place in the operating theatre in each case, and the case studies in Section 3 focus in more detail on an example of each one of these to help you understand the care of the patient in the various perioperative environments.



Day surgery


Oakley (2010:35) describes day surgery as ‘a specialist area of care where patients are admitted into a designated day surgery unit for minor and intermediate surgery, and discharged home the same day’. Examples of the types of surgical intervention you will see in a day surgery operating theatre are given in Box 8.1.



Box 8.1 Types of surgical intervention in a day surgery operating theatre




image  Orchidopexy.


image  Circumcision.


image  Inguinal hernia.


image  Excision of breast lump.


image  Anal fissure dilation and excision.


image  Haemorrhoidectomy.


image  Laparoscopic cholecystectomy.


image  Varicose vein stripping and ligation.


image  Transurethral resection of bladder tumour.


image  Excision of Dupuytren’s contracture.


image  Carpal tunnel decompression.


image  Excision of ganglion.


image  Arthroscopy.


image  Bunion operations.


image  Removal of metalware.


image  Extraction of cataract with/without implants.


image  Correction of squint.


image  Myringotomy.


image  Tonsillectomy.


image  Submucous resection.


image  Reduction of nasal fracture.


image  Operation for bat ears.


image  Dilatation and curettage/hysteroscopy.


image  Laparoscopy.


image  Termination of pregnancy.


(From The Audit Commission ‘basket of 25’ (Audit Commission 2001) cited in Oakley (2010:36))


Other, more major procedures can be undertaken according to the British Association of Day Surgery (Oakley 2010) but these are considered on a strict protocol and individual basis.



image Activity


Prior to your placement, identify exactly what each of the different kinds of surgery in Box 8.1 entails and make notes about each of them. After your placement is complete, check which ones you actually saw in a day surgery or other context and reflect on your experience in caring for patients in each situation.



image Tip


Read the chapter by Oakley (2010) on day surgery if possible before you go to your day care surgery placement or other perioperative placements.


The articles by Mitchell (2010) and Mottram (2011) (see References) are also helpful.

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Related posts:

  1. Case study 1: caring for a patient in a day care unit
  2. Case study 2: caring for a patient in a general surgical ward
  3. Recovery from surgery
  4. Preparation for and undergoing an anaesthetic prior to surgery

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Mar 18, 2017 | Posted by in NURSING | Comments Off on Undergoing surgery: the operating theatre experience

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