In my 20 years as a perioperative nurse, I've learned the value of good communication between myself and my patients, as well as the members of the surgical team. My primary goal is to connect with them and establish a true understanding with everyone. In my experience, I've found that communication isn't always enough to ensure we connect.
We all know that many medical errors are related to breakdowns in communication. In the surgical domain, where error rates are particularly high, critical information is often transferred in a reactive, ad hoc manner and communicative tension is common.1
Have you ever experienced a situation in which communication occurred but connection didn't? For example, as new nurses, many of us were exposed to rites of passage. When I first began my surgical career as a nurse's aide, I was sent by a surgeon for a "fallopian tube." Eager to please, I did my best to find it!! Obviously, communication happened here, but connection definitely didn't. Part of the reason this story is funny is that there was no real consequence, other than a lesson for me to listen more and react less. Not all lapses in communication and connection can be handled so easily.
Connection in the OR
At a recent advanced cardiac life support program I attended, the leader shared a technique he uses during a code situation to promote connectedness to the emergency response team. When directing team members, he touches one of them lightly on the shoulder and gives a direction in a calm, authoritative voice. For example, he might say, "Please make sure the suction is working." This technique ensures that the team member hears his direction, and instead of four people running to get supplies, only one does.
We use verbal, nonverbal, written, and electronic techniques to communicate. We connect by using checklists, audibly and concurrently counting sharps, instruments, and sponges between the circulator and the scrub person, and through standardized protocols.
The universal protocol is employed to prevent wrong-site, wrong-procedure, or wrong-person surgery. Connectedness occurs between the patient and the nurse when the patient marks laterality of the procedure in the presence of the nurse. The surgical team connects during the surgical pause to verify the correct patient, correct procedure, and correct surgical site. The surgical pause protocol advocates active communication among all members of the surgical/procedure team, consistently initiated by a designated member of the team and conducted in a "fail-safe" mode. The procedure isn't started until any questions or concerns are resolved.
Communication and connection can also be enhanced through new tools and techniques that are continually evolving. One such technique used extensively in healthcare organizations is SBAR. SBAR is an acronym for situation, background, assessment, and recommendation. The communication model offers an approach for providing information in an effective, succinct manner.
Publishing connections
As the newly appointed editor-in-chief of OR Nurse 2007, I look forward to connecting with you, the reader. I invite you to communicate and connect with your colleagues through this journal. What topics are you interested in reading about? What do you think about our first two issues? Be sure to e-mail me your suggestions and comments. The editorial staff and I look forward to connecting with you in the months and years to come!!
Elizabeth M. Thompson, RN, MSN, Editor-in-Chief
Nursing Education Specialist, Mayo Clinic, Rochester, Minn.
[email protected]
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