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Terhi’s diary

Thursday 17th May 2012 09:00

The first time I was inside an operating theatre I was about five and had tonsillectomy done. The only two memories that I have of the experience are that I was eating tons of ice-cream afterwards, and a photo of me sleeping in hospital after my tonsils were gone. This Thursday, it was my second time at an operation theatre. Having dressed in blue scrubs (which are better than pyjamas!) and done a fantastic tour around the hospital floor with a senior theatre team member (whom I shall call “Kate”, not her real name), Sharon and I were allowed in to observe an operation. The patient was a young boy. He was brought into the theatre that was full of people wearing gowns, masks, gloves and scary looking machines – no wonder he was scared. It was heart-breaking to see the boy cry, but his mum was allowed in to hold his hand just until he was asleep. Going to sleep in itself was rather beautiful to watch as it happened very smoothly in the competent hands of an anaesthetist.

The team working on the boy’s appendicectomy consisted of two surgeons (one of them must have been a registrar), a trainee scrub nurse and his mentor, a few circulating nurses and possibly other trainees or medical students. It was really interesting to observe what actually goes on during surgery, and how the team members accomplish a complex task of fixing a person. One thing that struck me was that I struggled to hear what these people wearing masks were saying to each other, even as I moved closer and stood right behind the operating surgeon. Nevertheless the operation progressed smoothly; I’m fascinated how these interactions unfold, after all surgery is accomplished through communication – whether vocal or non-vocal. I also noted that different levels of experience can affect how the team members attend to the conduct of others which is extremely interesting to me as a social interaction researcher. A wonderful example was Kate’s responsiveness to the eye-gaze of the mentor who was standing by the instrument trolley with the trainee scrub nurse. Kate quickly noted  the mentor’s “circulating” gaze, swiftly approached her and asked what she needed. Instances like this are beautiful examples of what we might mean by multimodal communication, how we conduct analyses of each others’ gaze, body movement, and gestures with or without talk. I look forward to examining these sort of things more closely throughout the project.

Tuesday 12th June 2012 08:30 ~ Morning at the Orthopedics

Yesterday was a good day as we got to know several team members in different theatres – a surgeon, nurses and two anaesthetists. It was really good to get to know people and they seemed quite interested in our project; many also shared their thoughts and feelings about communication and teamwork which was great. This morning, Sharon and I got to the theatres early again. We got to see an orthopedic surgery which meant wearing masks and led gowns because of x-ray machines going around. I’m quite impressed how the staff can wear these gowns for many hours as they are really heavy! The orthopedic surgery is quite fascinating and somewhat different to the operations I’ve seen so far. The surgeons were drilling and nailing a patient’s leg (you literally get a feeling they are fixing people!) and I saw a radiographer operating the x-ray machine first time during an operation. I noted how the participation of the radiographist involves a fluid realignment of eye-gaze between the x-ray screens and the operating surgeons, while the movement of the machine itself involves not only following the instructions from the surgeons but also monitoring their body movement. It’s  great to see how these professionals accomplish surgery fundamentally in and through interactions with each other, and I feel like I’m looking everything with fresh eyes. Sharon is an excellent companion and colleague as she knows the life in theatres very well and also quickly notes and responds if a nurse needs a hand with something. I remain conscious and watch where I put myself so as not to stand in the wrong place or be mistaken for a nurse!

Wednesday 20th June 2012 ~ Emergency Management of Severe Burns

On Wednesday we had a burns simulation day at the College organised by a visiting Plastics Registrar. The scenario was based on the emergency management of severe burns at A&E, developed to explore the use of simulation as an educational tool. The scenario involved assessing a burns patient (i.e. an actor with make-up representing burns and injuries) and instigating initial management through a team of participants (nurses, medical students, registrars, consultants) in what was designed to resemble a realistic resuscitation environment. Simulation scenarios are increasingly used in medical and surgical training, and their potential resides exactly in their capacity to create realistic episodes that do not rely on imagination or hypothetical thinking, but rather on real action.

It is not only the settings that are realistic (for example, most of the items used are as found in an emergency room, an ECG machine has been created from an IPad, the background is set up visually to recreate the environment of an emergency room or an operating theatre, etc.) but also the way the participants to a scenario work as a team as they would do in real settings. From a social interaction perspective simulation scenarios are particularly interesting insofar as they offer a glimpse of how the team of professionals might organise their conduct to accomplish, for example, an emergency management of burns. However, they also offer a demonstration as to how the participants to a scenario orient to the settings and to each other both as actors as well as professionals. Our lovely Sharon participated as a nurse in several scenarios throughout the day and you can see her in action in the photo below!

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