An observational study of surgery-related activities between nurses and surgeons during laparoscopic surgery.

BACKGROUND In the operating room (OR), nurse-surgeon coordination is essential to the success of a surgery. METHODS This observational field study was conducted in the OR for selected laparoscopic surgeries to record surgery-related activities (SRAs) performed by the scrub nurses with different levels of OR experience. Those SRAs performed without instruction were defined as anticipatory movements. RESULTS The scrub nurse spent 74% of OR time watching surgery and 35% of OR time performing SRAs. The intermediate skill nurses watch surgeon on 76% of the OR time and they performed 16 counts of anticipatory movements per procedure. Experienced nurses spent shorter amount of OR time (72%) watching surgery but they performed more anticipatory movements (20 counts) than the intermediate skill nurses. With basic cases, experienced and intermediate-skill nurses performed equal amounts of anticipatory movements; however, when assisting in complex cases, the experienced nurses performed significantly more anticipatory movements (24 counts) than the intermediate-skill nurses (16 counts). CONCLUSIONS Experienced nurses develop sophisticated cognition during their careers in the OR, which allows them to maintain their involvement with the surgical team consistently. The anticipatory movement and the eye gaze are 2 valuable behavioral markers for assessing team performance.

[1]  M R de Leval,et al.  The human factor in cardiac surgery: errors and near misses in a high technology medical domain. , 2001, The Annals of thoracic surgery.

[2]  M. I. Núñez-Peña,et al.  Effects of dynamic rotation on event-related brain potentials. , 2005, Brain research. Cognitive brain research.

[3]  K. Taxis,et al.  An observational study of intravenous medication errors in the United Kingdom and in Germany , 2003, Pharmacy World and Science.

[4]  Lorelei Lingard,et al.  Team Communications in the Operating Room: Talk Patterns, Sites of Tension, and Implications for Novices , 2002, Academic medicine : journal of the Association of American Medical Colleges.

[5]  David W Bates,et al.  Medication errors observed in 36 health care facilities. , 2002, Archives of internal medicine.

[6]  F. Jacob Seagull,et al.  Cultural and institutional conditions for high reliability teams , 2004, 2004 IEEE International Conference on Systems, Man and Cybernetics (IEEE Cat. No.04CH37583).

[7]  C. Mackenzie,et al.  Video techniques and data compared with observation in emergency trauma care , 2003, Quality & safety in health care.

[8]  Eduardo Salas,et al.  Team Performance Assessment and Measurement: Theory, Methods, and Applications. Series in Applied Psychology. , 1997 .

[9]  Molly Cooke,et al.  American medical education 100 years after the Flexner report. , 2006, The New England journal of medicine.

[10]  J Carthey,et al.  The role of structured observational research in health care , 2003, Quality & safety in health care.

[11]  Elliot E. Entin,et al.  Adaptive Team Coordination , 1999, Hum. Factors.

[12]  J Savage,et al.  Ethnography and health care , 2000, BMJ : British Medical Journal.

[13]  Eduardo Salas,et al.  Planning, Shared Mental Models, and Coordinated Performance: An Empirical Link Is Established , 1999, Hum. Factors.

[14]  Nick Barber,et al.  Ethnographic study of incidence and severity of intravenous drug errors , 2003, BMJ : British Medical Journal.

[15]  B. B. Morgan,et al.  Team Workload: Its Meaning and Measurement , 1997 .

[16]  Eileen B. Entin,et al.  Training Teams for the Perioperative Environment: A Research Agenda , 2006, Surgical innovation.

[17]  P. Bower,et al.  Team structure, team climate and the quality of care in primary care: an observational study , 2003, Quality & safety in health care.

[18]  M Dixon-Woods,et al.  Deriving recommendations in clinical practice guidelines , 2003, Quality & safety in health care.