Opinions
OR nurses look at the circulator role How do you see your role as circulator? What do you think are your most important functions? How do you use nursing judgment in carrying out these functions? Three operating room nurses examine their roles as circulating nurses and respond to these questions.
“The OR circulator should see herself as the patient’s advocate.”
The circulating nurse, like all other nursing personnel, must first of all care about people. Nursing signifies caring. Primarily, the operating room circulator should see himself or herself as the patient advocate’-the individual who cares enough to deliver planned, knowledgeable, and professional nursing care from the first preoperative visit to the patient’s discharge from the hospital. Often, the presurgical patient is a frightened and insecure individual. Preoperatively,the operating room circulator meets the patient and begins to communicate to that individual assurance and familiarity with the impending surgical procedure. The circulator then begins to act as liaison between the patient and the surgeon and other nursing personnel to provide continuity of nursing care. As the circulating nurse listens to the patient and talks with him, a certain amount of confidence is instilled and his fear alleviated. The anesthetized patient is literally at the mercy of the surgeon, the anesthesiologist, and the circulating nurse. For the operation to be carried out expeditiously, the surgeon must concentrate on operating and put his or her trust in the reliability of the clinically astute circulator. The patient’s safety is the paramount concern, and because the patient cannot speak up for himself, it is the circulator who must be alert to any incongruities occurring from the moment of arrival in the operating room to that point of transfer to the recovery room. Correct anatomical
d+ 766
AORN Journal, March 1979,Vol29, No 4
“The circuktor must alignment on the surgical table as well as proper be alert to any tourniquet and Bovie application are a few examples of incongruities.” such responsibilities.
Supervision of operating room personnel includes being alert for possible contamination to protect the patient from infection. Teaching medical and nursing students operating room procedures and standards should be done in a consistent and conscientious manner. The importance of each surgical patient as a vulnerable individual should not be minimized. A circulator must be prepared in advance for each patient’s visit to the operating room. Emergency situations should be anticipated to be able to respond promptly and efficiently. Likewise, anticipating the needs of the surgeon, scrub nurse, and anesthesiologist affords the patient the best advantage of a shorter and more economical anesthetic. The safety of operating room personnel must not be overlooked, and again, the circulating nurse is the overseer. Proper handling of contaminated objects, specimens, and needles is important in lessening the incidence of hepatitis and other nosocomial infections. Basically, if the operating room circulator places himself or herself in the position of the patient and treats each individually with the same consideration and care he or she would like to receive, the tendency rather than the exception would be excellent and competent nursing care. Theresa M Rucker, RN Alternate coordinator-OR Veterans Administration
“The safety of OR personnel must be overlooked.”
Medical Center Reno, Nev Note 1. Sandra C Hesterly, “You are the patient’s advocate,” AORN Journal 1 7(April 1973)204-209.
The role of circulator is multidimensional with the potential of being the most challenging and satisfying among nursing’s ever-expanding specialties. Potential is the key word because the circulator’s role varies on a continuum from technical, task-oriented functions to the fulfillment of purpose of professional nursing. The circulator has the opportunity and the responsibility to perform highly technical psychomotor skills as well as exercise his or her highest level of cognitive skills. Many nursing positions today lack this combination. Together, these factors are responsible
AORN Journal, March 1979, V o l 2 9 , N o 4
771
“&ycho/ogica/ and for high-quality patient care and self-satisfaction for the physicat well-being circulator. Psychomotor skills are necessary in technical,
cannot be task-oriented functions, which must be performed separated*” safely for the patient’s physical well-being. Cognitive
“The nursing process is the way to use our fU// pOtentk/,”
skills are essential in using the nursing process, which enables the nurse to care for the patient’s psychological well-being. Physical and psychological well-being cannot be separated nor ignored while giving “adequate,” “good,” “total,” “holistic,” or “professional” nursing care. The way to use our full potential and attain self-satisfaction as registered professional nurses is through the nursing process with its systematic documentation. Assessment, planning, and evaluation require cognitive skills, while implementation requires psychomotor skills. Preoperativevisits and intraoperative nursing care plans are essential in giving patients individualized, high-quality nursing care. The circulator then has the basis for making nursing judgments during the implementationof his or her plan if alterations are necessary. Evaluation is impossible if there is no preplanning on which to base the care given. I believe any intelligent, coordinated, and willing person can be taught the technical, task-oriented functions of the role of the circulator (as has been done in the scrub position), but only the registered nurse with his or her educational preparation can prepare and implement the nursing plan that is the basis for quality patient care-and isn’t this the reason we’re all here? Linda RN OR staff nurse Greenville (Pa) Hospital
As a circulating nurse, I am a professional member of a support system in a comprehensive health care team. A circulating nurse has the distinct role of identifying and meeting the needs of all individual health care specialists comprising the surgical team. Being an important participant of this support system helps ensure quality patient care, which is the main priority during surgical intervention. It is difficult to specify which functions of the circulator are most important. All are essential in maintaining quality patient care, but I believe the following functions need to be stressed.
772
AORN Journal, March 1979, V o l 2 9 , No 4
1. Maintenance of surgical asepsis. A circulating “The circulator serves nurse must be aware of any break in aseptic technique as a role mode/ for and must feel comfortable in calling attention to any the team. J J
deviation. The circulator must also concentrate on his or her own technique and serve as a role model for the team. 2. Assurance of patient safety. Proper use of equipment, appropriate positioning of patients, accurate protocol for sponge and needle counts, and knowledge in resuscitative procedures are functions of a circulator that assure the safety of patients. 3. Patient advocate. Being called a patient advocate is a more recent term in nursing, but it is not a new concept for the circulating nurse. This function is vital for quality care of the unconscious patient. Nursing judgment is essential in carrying out these functions. If the circulator observes any technique that is questionable, he or she should automatically report this judgment. The circulator may also decide when the scrubbed person needs assistance or verbal support. In assuring patient safety, the circulator’s judgment is ongoing. He or she decides if positioning is appropriate, if sponge counts meet standards, and when the anesthesiologist needs additional assistance. In the event of intraoperative emergency, the circulator determines the priority of needs and if he or she needs additional reinforcements. Nursing judgment is essential for being an effective patient advocate. The circulator protects the modesty of the unconscious patient, is aware of the exact procedur%e being performed, and will question procedures not specified through surgical consent if this is appropriate in his or her judgment. The circulating nurse uses constant nursing judgment as patient advocate by continually striving for quality care and by protecting the patient from the means that would threaten this care.
“The circulator’s Meg Kennedy, RN judgment is OR staff nurse ongoing. ” Evanston (111) Hospital
774
AORN Journal, March 1979, Vol29, No 4
OR nurses look at the circulator role How do you see your role as circulator? What do you think are your most important functions? How do you use nursing judgment in carrying out these functions? Three operating room nurses examine their roles as circulating nurses and respond to these questions.
“The OR circulator should see herself as the patient’s advocate.”
The circulating nurse, like all other nursing personnel, must first of all care about people. Nursing signifies caring. Primarily, the operating room circulator should see himself or herself as the patient advocate’-the individual who cares enough to deliver planned, knowledgeable, and professional nursing care from the first preoperative visit to the patient’s discharge from the hospital. Often, the presurgical patient is a frightened and insecure individual. Preoperatively,the operating room circulator meets the patient and begins to communicate to that individual assurance and familiarity with the impending surgical procedure. The circulator then begins to act as liaison between the patient and the surgeon and other nursing personnel to provide continuity of nursing care. As the circulating nurse listens to the patient and talks with him, a certain amount of confidence is instilled and his fear alleviated. The anesthetized patient is literally at the mercy of the surgeon, the anesthesiologist, and the circulating nurse. For the operation to be carried out expeditiously, the surgeon must concentrate on operating and put his or her trust in the reliability of the clinically astute circulator. The patient’s safety is the paramount concern, and because the patient cannot speak up for himself, it is the circulator who must be alert to any incongruities occurring from the moment of arrival in the operating room to that point of transfer to the recovery room. Correct anatomical
d+ 766
AORN Journal, March 1979,Vol29, No 4
“The circuktor must alignment on the surgical table as well as proper be alert to any tourniquet and Bovie application are a few examples of incongruities.” such responsibilities.
Supervision of operating room personnel includes being alert for possible contamination to protect the patient from infection. Teaching medical and nursing students operating room procedures and standards should be done in a consistent and conscientious manner. The importance of each surgical patient as a vulnerable individual should not be minimized. A circulator must be prepared in advance for each patient’s visit to the operating room. Emergency situations should be anticipated to be able to respond promptly and efficiently. Likewise, anticipating the needs of the surgeon, scrub nurse, and anesthesiologist affords the patient the best advantage of a shorter and more economical anesthetic. The safety of operating room personnel must not be overlooked, and again, the circulating nurse is the overseer. Proper handling of contaminated objects, specimens, and needles is important in lessening the incidence of hepatitis and other nosocomial infections. Basically, if the operating room circulator places himself or herself in the position of the patient and treats each individually with the same consideration and care he or she would like to receive, the tendency rather than the exception would be excellent and competent nursing care. Theresa M Rucker, RN Alternate coordinator-OR Veterans Administration
“The safety of OR personnel must be overlooked.”
Medical Center Reno, Nev Note 1. Sandra C Hesterly, “You are the patient’s advocate,” AORN Journal 1 7(April 1973)204-209.
The role of circulator is multidimensional with the potential of being the most challenging and satisfying among nursing’s ever-expanding specialties. Potential is the key word because the circulator’s role varies on a continuum from technical, task-oriented functions to the fulfillment of purpose of professional nursing. The circulator has the opportunity and the responsibility to perform highly technical psychomotor skills as well as exercise his or her highest level of cognitive skills. Many nursing positions today lack this combination. Together, these factors are responsible
AORN Journal, March 1979, V o l 2 9 , N o 4
771
“&ycho/ogica/ and for high-quality patient care and self-satisfaction for the physicat well-being circulator. Psychomotor skills are necessary in technical,
cannot be task-oriented functions, which must be performed separated*” safely for the patient’s physical well-being. Cognitive
“The nursing process is the way to use our fU// pOtentk/,”
skills are essential in using the nursing process, which enables the nurse to care for the patient’s psychological well-being. Physical and psychological well-being cannot be separated nor ignored while giving “adequate,” “good,” “total,” “holistic,” or “professional” nursing care. The way to use our full potential and attain self-satisfaction as registered professional nurses is through the nursing process with its systematic documentation. Assessment, planning, and evaluation require cognitive skills, while implementation requires psychomotor skills. Preoperativevisits and intraoperative nursing care plans are essential in giving patients individualized, high-quality nursing care. The circulator then has the basis for making nursing judgments during the implementationof his or her plan if alterations are necessary. Evaluation is impossible if there is no preplanning on which to base the care given. I believe any intelligent, coordinated, and willing person can be taught the technical, task-oriented functions of the role of the circulator (as has been done in the scrub position), but only the registered nurse with his or her educational preparation can prepare and implement the nursing plan that is the basis for quality patient care-and isn’t this the reason we’re all here? Linda RN OR staff nurse Greenville (Pa) Hospital
As a circulating nurse, I am a professional member of a support system in a comprehensive health care team. A circulating nurse has the distinct role of identifying and meeting the needs of all individual health care specialists comprising the surgical team. Being an important participant of this support system helps ensure quality patient care, which is the main priority during surgical intervention. It is difficult to specify which functions of the circulator are most important. All are essential in maintaining quality patient care, but I believe the following functions need to be stressed.
772
AORN Journal, March 1979, V o l 2 9 , No 4
1. Maintenance of surgical asepsis. A circulating “The circulator serves nurse must be aware of any break in aseptic technique as a role mode/ for and must feel comfortable in calling attention to any the team. J J
deviation. The circulator must also concentrate on his or her own technique and serve as a role model for the team. 2. Assurance of patient safety. Proper use of equipment, appropriate positioning of patients, accurate protocol for sponge and needle counts, and knowledge in resuscitative procedures are functions of a circulator that assure the safety of patients. 3. Patient advocate. Being called a patient advocate is a more recent term in nursing, but it is not a new concept for the circulating nurse. This function is vital for quality care of the unconscious patient. Nursing judgment is essential in carrying out these functions. If the circulator observes any technique that is questionable, he or she should automatically report this judgment. The circulator may also decide when the scrubbed person needs assistance or verbal support. In assuring patient safety, the circulator’s judgment is ongoing. He or she decides if positioning is appropriate, if sponge counts meet standards, and when the anesthesiologist needs additional assistance. In the event of intraoperative emergency, the circulator determines the priority of needs and if he or she needs additional reinforcements. Nursing judgment is essential for being an effective patient advocate. The circulator protects the modesty of the unconscious patient, is aware of the exact procedur%e being performed, and will question procedures not specified through surgical consent if this is appropriate in his or her judgment. The circulating nurse uses constant nursing judgment as patient advocate by continually striving for quality care and by protecting the patient from the means that would threaten this care.
“The circulator’s Meg Kennedy, RN judgment is OR staff nurse ongoing. ” Evanston (111) Hospital
774
AORN Journal, March 1979, Vol29, No 4
