Thursday 17th May 2012 09:00
This was my first introduction to the operating theatres of the hospital. We were met by a member of the theatre team who quickly set us up with the necessary badges, lockers and scrubs.
We were then taken on a tour of the operating theatres, including patient waiting rooms, equipment storage and the recovery area. Apart from a different layout, this was all very familiar to me with only small differences, such as the use of an electronic equipment ordering system and camcorders in the light handles.
We were asked if we wanted to watch a small operation, to which we responded enthusiastically. The procedure was an open appendisectomy on a child of about 8 years old. This was a procedure I was very familiar with and memories of my time as a theatre practitioner came flooding back.
The scrub nurse for the operation was a trainee OPD who was being mentored by a senior nurse. There was also one circulator, the consultant surgeon and two junior Doctor assistants, as well as the anaesthetist and another OPD.
I watched the scrubbed OPD do his instrument and swab count and prepare the instruments and drapes to enable the surgeon to commence the operation. I was struck by how exactly alike this procedure is even in a different hospital with different staffing.
At first I felt as though I needed to revert back into a nursing role and help to facilitate the operation. It felt alien to stand back and watch and not use the skills I had been trained in. However once I adjusted to the environment I was able to see the whole scenario from a completely different perspective and felt privileged at having the opportunity.
One of the team members was very helpful in talking us through what was happening and in giving us ideas of where would be best to record from and where would not. I was aware that it was my colleague Terhi’s first time in an operating theatre and was mindful to check that she was ok; however she appeared enthralled by the experience.
As the operation closed we watched the swab count and got talking to one of the theatre nurses. The environment was very relaxed and she advised that she would be happy for us to video record her once our research commenced which was extremely encouraging.
Friday 25th May 2012 14:00
Today we decided to take a wonder around the theatres in order to familiarise ourselves with the environment and get our faces known. This turned out to be not as straight forward as we had expected.
As we entered the corridors to the theatres we were approached and asked who we were. We explained who we were and were allowed to continue, however we appeared to be attracting attention as to our purpose for wondering around the theatres without an obvious look of somewhere to be.
We decided to leave the theatres and visit the theatre team member we were familiar with to discuss certain aspects of the project with her. When we arrived at her office she wasn’t there and we were advised that she was in theatres.
Just as we were about to leave she appeared and asked if there was anything we wanted. I noticed quickly that she appeared slightly stressed and asked her if she was ok. She advised in a very matter of fact manner that she had just come from a trauma case where they had been trying to save a man’s life that had been stabbed several times.
Terhi was immediately shocked about this and was amazed at how matter of fact she had been about it. I saw this as perfectly normal and understood the frequency of events like this in this environment and the need to normalise them.
We could see she was busy and left with the view to come back at a more convenient time.
Tuesday 29th May 2012 09:30
We arrived at our office to an e-mail from a member of the theatre team advising us that someone we should meet was on sight and would we like to come and meet her. We headed straight for the theatres, however when we arrived we were advised that we had just missed her.
We chatted to the team member briefly and said we would contact the person we had missed to arrange another meeting. We also asked if we could be introduced to other member’s within the theatre by her in order for people to become more familiar with us and prevent the reactions that had occurred last time we had entered theatres.
As we left, Terhi asked me if I had seen the knife on the desk. I hadn’t seen it at all and so turned back to see what she was talking about. Right there in front of the team members desk was a blood stained knife about 30cm long in a clear container which I had failed to notice. The team member advised that it was from another stabbing she had attended (not the one we had seen her after) and that she was waiting for the police to collect it.
Terhi couldn’t believe that I hadn’t noticed it and I was surprised at how desensitized to this sort of thing I must have become after seeing Terhi’s reaction.
Thursday 7th June 2012 10:00 & 14:30
Today we met the theatre team member we missed the last week. It was a brief meeting and she was very pleasant and gave us some good ideas regarding the research project. She was intrigued to learn I had previously been a theatre practitioner. Once we began discussing this it became apparent that we had both worked at the same hospital albeit at different times. From this we were able to compare stories and thoughts on that particular hospital.
I asked her if there was anything in particular she was concerned about with our undertaking of the project. She advised that as I had been a theatre nurse she was happy that I understood all the “housekeeping rules” and that I could pass this knowledge onto my colleague. She also introduced us to another team member, whom advised that they could introduce us to different teams on different days.
Our theatre link advised us of the theatre audit that would be taking place in July and asked asked if we would like to do a talk for it. This was a fantastic opportunity for us to get to meet a large number of the theatre teams at once, get our faces recognised and promote the project, so a date was booked.
Later that day we were introduced to another team member who worked at a different theatre site, she also had some good ideas for our project and a date was booked for a visit to the theatres where she worked. She too was intrigued to learn I was a nurse with a background in theatres and we also had a short discussion regarding this.
Monday 11th June 2012 07:30
Today we had an early start as we wanted to arrive when all the theatre staff would be arriving. This meant that we could see how the day would be organised and also introduce ourselves before any cases begun.
We arrived a little early and not many people were about. I took Terhi to the equipment room as I remembered that’s where the nurses are likely to be getting the equipment they needed for the day. In there we found a nurse and introduced ourselves. She advised us to bleep the theatre coordinator to see what theatre would be best to spend the day in.
I bleeped the theatre coordinator who advised she was in handover but that she would come and find us later. The theatre we had used the telephone to bleep from was starting to fill with staff. We introduced ourselves and spoke to two nurses who advised they had only been working at the theatres since January. We asked if they minded us hanging around the theatre for the morning and they said that was fine. One of the nurses advised us to go to the tea room for a coffee as they hadn’t sent for the patient yet and it would be some time before anything began to happen. We took her advice and went to the staff tea room.
After a while we headed back only to be informed that there was no ITU bed and therefore the operation couldn’t go ahead at present. We decided to see if there was another theatre that we could spend time in. One of them already had an operation in progress, however a nurse was stood outside at our time of passing and once we explained who we were she said she would ask if it was ok for us to go in.
We were allowed in and slowly introduced ourselves to the team members, being careful not to cause too much disruption. Everyone was very pleasant and the consultant anaesthetist, registrar anaesthetist and OPD were all very interested in the project. They all gave us there thoughts on communication within the operating theatre. The OPD in particular felt that the system was too hierarchal and that this caused problems. The anaesthetist felt that there was too much management dictating to the system and not enough shop floor staff. All of them agreed that communication was very important within the operating theatre.
Once again the staff were intrigued to learn I had been a theatre practitioner myself and we discussed my previous employment and fellow colleagues we knew.
During the operation I noticed the scrub nurse make a request in my direction whilst her head was still looking down. When I didn’t respond she looked up and then made the request again and looked in the direction of the circulating nurse. I guess she must have presumed I was the circulator due to seeing the colour of my scrubs in her peripheral vision. This made me think about the communication aspect of our project.
After the operation was finished we wanted to speak to the consultant surgeon and introduce ourselves, however before we had a chance to notice he had already removed his gown and slipped out the door.
We hung around for the next operation. Fortunately this surgeon had turned up early and we were able to have an informal chat to him about what we were doing and what his next operation involved. This procedure was interesting as it was incredibly quick and only required the nurse to set up the instrumentation but not scrub for it. I remembered procedure like this were only a few instruments were needed which the surgeon was happy to do alone.
We decided to leave after this as the next three operations were to be the same and now that we had acquainted ourselves we didn’t want to get in the way. On our way out we thanked everyone and advised them we would be back soon.
Tuesday 12th June 2012 08:30
We didn’t arrive until a little later today as we felt we had been too early yesterday and didn’t want to be waiting unnecessarily again. As we arrived we saw a few familiar faces who we waved at which was a nice feeling and meant that we didn’t feel so intrusive to the environment anymore. We stopped to talk to the ODP we had met yesterday and he was telling us about the cases that had happened after we had left the day before.
After we had changed into scrubs we decided to see if we could spend some time in the orthopaedic theatres. Two were running simultaneously. I saw a nurse in the adjoining store room and introduced myself and asked if we could spend some time with them. She advised me of the nurse’s name in the theatre and that it shouldn’t be a problem.
We entered the theatre and the operation was just commencing so we quickly introduced ourselves and stood back out of the way. We had to wear led gowns as x-rays were being taken and Terhi couldn’t believe how heavy they were.
In this theatre everyone had to wear masks due to infection control and this made the communication aspect even more interesting to watch. The difference in how the radiographer interacted with the rest of the ‘team’ was also unique and something that I had noticed myself when I was a scrub nurse.
Now that I felt more settled in the environment, I found myself reverting back to a nursing role. In particular, I was concerned about aspects such as doors being left open, therefore affecting the air ventilation system. I quickly recognised this tendency and reminded myself of my new role within the theatre environment.
During the operation we were able to speak with the anaesthetist and also the circulator about the project. Whilst the surgeon was plastering the patients’ leg we also discussed with him what the project was about and he appeared very keen with lots of questions.
We said our goodbyes again and one of the nurses stopped us to ask when we would be back again. We told him soon and gave him the website address. It was nice that he was so friendly and enthusiastic about our return.
Monday 18th June 08:45
Monday morning and we headed to theatres again. We were definitely becoming more comfortable in the environment and were once again recognised by some of the theatre staff. We opted to watch an operation that we had seen last week because it was just about to commence and the staff were happy for us to be there.
The same surgeon was performing the surgery, however the anaesthetic and nursing team were different. Once again the team were intrigued to learn what we were researching. One of the nurses described to us the importance of predicting what will happen next in order to be one step ahead the whole time.
After the operation had finished we went to look for another occupied theatre. An operation was already in progress and we weren’t sure if we should enter or not. Just at that moment one of the nurses we had met last week came out of the theatre and immediately recognised us. She asked how we were and then invited us to come and watch the procedure which was an esophagectomy.
We were told the procedure could take anything between four to eleven hours. The scrub nurse advised that she would swap half way with someone if it were the latter time. The circulating nurse operated the handle light cameras for us and gave me a quick introduction to how they work. It was useful for us to know this for when we start our own filming.
An interesting part today was when a medical student entered the theatre. The consultant surgeon asked him to ‘scrub up’. He was taking his time getting scrubbed up and the consultant surgeon kept looking back to see where the student was. At one point the student asked if I could help him and when I went to tie his gown it became apparent that it was too small. He also pulled the cord apart before giving it to me which meant I was unable to tie his gown for him. He then confessed that he hadn’t done this for a long time and was a bit out of practice. I think nerves may have also played a part.
I helped him to finish gowning and then he headed into the theatres. The consultant surgeon didn’t acknowledge him at first and the medical student kept looking at his hands awkwardly. Eventually the scrub nurse advised the consultant that the medical student was behind him and he turned to him and advised him to move into a better position. The whole time we were there the student appeared uncomfortable in his surroundings.
Due to the length of the procedure, myself and Terhi opted to leave at lunch time and said our goodbyes.
Tuesday 19th June 2012 09:00 2012
Today we had an appointment to meet the sister of some newly renovated theatres. We were told that the teams who worked in these theatres were fairly stable and had worked together for a long period of time. The sister met us in the team room and promptly got us fitted out with scrubs and shoes.
The theatre was much bigger than the others we had seen and was very high-tech. We introduced ourselves and the atmosphere was light-hearted with all members of the team laughing and making jokes. Everyone appeared very at ease with each other and there was a lot more verbal communication than we had previously seen.
The nurses and anaesthetist often looked round and smiled at us. At one point the consultant surgeon made a joke and asked if we were documenting the differences in work being done by him compared to the anaesthetist, everyone laughed.
The operation was a laparoscopic nephroureterectomy and although the procedure appeared quite complex with an array of instruments being used, everyone remained relaxed.
We left the operation half way through and discussed dates we could return with the sister.
Wednesday 27th June 2012 09:00
We had arranged to meet one of the surgeons today via e-mail. He advised that it would be beneficial for us to watch two very different types of operations that he performed.
The surgeon wasn’t operating himself on this day but instead had a registrar that he was supervising. We recognised the nurses and ODP in this theatre which allowed us to feel more comfortable in the environment. There was a new Anaesthetist whom we introduced ourselves to.
The operation itself was done laparoscopically and therefore we watched in amusement as the different team members communicated whilst looking in different directions at different screens. The consultant surgeon always had one eye on a screen, even when he was talking with others about something unrelated.
Another interesting aspect today was that there was music being played. It was quite loud and the registrar appeared to be enjoying it. It appeared to contrast the other operations we had observed where noise was kept to a minimum.
Thursday 28th June 2012 09:00
We headed to theatres again today to meet another surgeon we had arranged to. Unfortunately when we arrived the list had changed and another surgical team was using the theatre. Due to time and having to go to another building we decided to stay where we were.
This was a very straight forward hernia repair and the environment reflected this in the way in which everyone talked more freely and appeared less concerned.
Tuesday 3rd July 2012 09:00
We were back to the main theatres again today after arranging with one of the surgeons to see a different location and type of operation that he would perform. When we arrived we recognised a good percentage of the staff and so no formalities were needed.
The operation itself was set to be a long one (between 6-8 hours). It appeared that the staff were preparing the theatre with this in mind. The WHO checklist was also done precisely to ensure that everything was ready and everyone knew who each other was.
Once the operation commenced, myself and Terhi noticed how ‘transient’ the room was in that many different people were entering and leaving the theatre throughout the operation. At one point the surgeon looked up at a person who had not long arrived and asked “who are you?”. That person replied that they were a medical student.
People continued to come and go and it was hard to keep track on who was who. This contrasted to the last operating theatre we had been in where only the working staff were involved and everyone knew who each other was.
Thursday 19th July 2012 08:15
On 19th July we were asked to participate in a cadaver simulation day at the Royal college of surgeons. Initially we were only going to observe in order to give our thoughts and opinions on how we felt the simulation went, however after further thought we asked the organisers if we could do some filming of the simulation in order to obtain data for our own analysis. They were happy for us to do this and we took our equipment along.
The cadaver being utilised was fresh frozen in order to provide a realistic simulation. Due to this aspect, the researchers were concerned with how people felt about training in this manner and in particular with regards to smells and ethical concerns.
When I first entered the simulation room that had been set up to represent an operating theatre, the first thing I noticed was the smell. Although not particularly potent, combined with the sight of the cadaver, I felt a little uneasy at first. However as the day went on and the room was transferred into what felt like a real theatre environment, these issues no longer appeared to bother me.
The simulation itself was very good and very realistic. The researchers had even managed to introduce fake blood into the cadaver, giving the scenario even more realism. The operating team themselves seemed to get completely caught up in the scenario and one surgeon commented after that his heart had been racing throughout the procedure.
Another important aspect of the simulation was that there was a full operating team present, such as nurses, ODP’s, anaesthetist’s and surgeons and not just one health care professional group which is usually the case in simulation scenarios. Even one of the lab technicians commented on how they had never seen a simulation appear so real in their laboratories before.