AN ENVIRONMENT FOR SURGICAL CONSCIENCE

What is Surgical Conscience?

Surgical Conscience is a skill that is learned in the perioperative setting. Surgical Conscience is a moral obligation to recognize when there is a break in sterile technique or asepsis. It is also recognizing when a patient's safety is at risk. While perioperative nurses and team members are aware of surgical conscience and feel that they should speak up, often it seems barriers in the operating room make this skill difficult to practice.

According to Duff & Bowen, et al, surgical conscience is divided into three parts of knowing, feeling, and acting (2022). The team member first is aware of the surgical surroundings, setting and safety protocol. Next, the team member knows an action was made that has put the patient at risk and he or she feels that they should speak up. Finally the team member speaks up and acts upon how they feel. When the nurse speaks up and acts on her findings, surgical conscience has been demonstrated and the nurse has done the right thing morally to protect their patient. 

Examples of Recognizing Surgical Conscience in the Operating Room

An example of surgical conscience would be recognizing a break in sterile technique. Maybe the prep was accidentally touched by an unsterile object after the patient was prepped. However, only the perioperative nurse noticed and the other members of the team did not. When the nurse speaks up, stops further actions and reapplies the prep in efforts to correct a break in sterile technique, she is practicing surgical conscience.

Another example of surgical conscience is avoiding applying compression devices, which have been proven to decrease the risk of blood clots postoperatively. This may occur because the surgery team was in a hurry. Although the workflow of the operating room is fast and turnovers are expected to be quick, slowing down and recognizing the actions that improve patient outcomes are essential. Awareness, recognition, and communication of what is right versus wrong in the surgical setting is crucial to promoting patient safety in the operating room.

Barriers to Practicing Surgical Conscience

Recognized barriers that prevent nurses from practicing surgical conscience exist in operating rooms across the world. The operating room is full of different personalities. One noted barrier is fear of resistance from other staff in the operating room. If a nurse speaks up, she maybe met with attitudes of eye rolling, sighs, and questioning from other team members (Quintana, 2023). In some cases, these personalities are so strong that the degree of conflict and stress they cause leads the nurse to remain silent when she should speak up.

Improving Surgical Conscience in the Operating Room

The asepsis break or risk of patient safety should be the greatest concern no matter what the risk, or delay. If any of the surgical team speaks out voicing surgical conscience, it should be acknowledged and appreciated. Managers must educate their surgical staff regarding surgical conscience and its importance. Patients are their most vulnerable in the operating room. They depend on the surgical team to provide the best care possible from airway management to proper positioning, ensuring sterility, and safety throughout the entirety of the procedure. When surgical conscience is practiced in an accepting environment, communication is improved and the patient has optimal outcomes. 

Duff, J., Bowen, L., & Gumuskaya, O. (2022). What does surgical conscience mean to perioperative nurses: An interpretive description. Collegian, 29(2), 147–153. https://doi.org/10.1016/j.colegn.2021.07.007

Danielle Quintana, P. (2023, October 20). Barriers to surgical conscience action scale. Aorn.org. https://www.aorn.org/article/barriers-to-surgical-conscience-action-scale

Assessed and Endorsed by the MedReport Medical Review Board