After spending almost two weeks with different anaesthetic nurses in different operating theatres we got allocated with couple of scrub nurses and circulating nurses. Usually in the OT there is one scrub nurse assisting the surgeons and at least two circulating nurses who assist the scrub nurse. Those three nurses then change places during the day so every of them works as a scrub nurse for some operation.
Before the operation scrub nurse and circulating nurses check the instruments for the operation in the preparation room. They have ready sets of instruments for different operations and before the operation the nurses check that the sets include everything by using a checklist and counting the items aloud. The instrument sets are packed sterile so they have to be also handled sterile by using sterile gowns and gloves as well as a face mask and a cap.
When entering the operating theatre the scrub nurse create a sterile working place by using sterile coverings. After this the nurse can place the instrument sets to the tables and organise them as she likes. The circulating nurses are assisting the scrub nurse to do this by passing the covering packages and instrument sets. They also prepare the other machines ready for the surgeons to use. One of these machines is the diathermy which is used to cauterize the blood vessels to prevent blood losses. The diathermy creates electrically induced heat so the electricity flows through the pen-like instrument and out of the body via another electrode placed usually the leg of the patient.
Before the operation the circulating nurses help the anaesthetic nurse to put the patient in right position. If catheterization is needed, the circulating nurse will do it. Also the patient safety check list is filled up by circulating nurse. During the operation the circulating nurses are ready to get more instruments and other things like needles and syringes to the scrub nurse and the surgeons if needed. Those extra instruments are documented and counted before using them. The circulating nurses also count the used swaps from the bin where the scrub nurse puts them and packs five same size swaps in one plastic bag as they are packed in fives to sterile packages.
Before the surgeons start to close the wound of the patient, the scrub nurse starts to count all the instruments, needles and swabs with the circulating nurse. The idea is to prevent any strange items to be left inside the patient. Sometimes this happens and the patient gets complications and the wound has to be reopened which of course increases the complications again and also extends the healing. After the counts have been done the scrub nurse tells the surgeons that they can start closing the wound.
After the operation the scrub nurse finishes the operation site of the patient by washing and covering it. After that the sterile coverings can be removed and patient is covered with sheets and blankets like before entering the operation theatre. The instruments are taken to the dirty utility room from where they are taken to be washed and sterilized.
We were not allowed to work as a scrub nurses as they usually are educated for the job after graduating. But we got really good picture of the responsibilities of both scrub nurse and circulating nurse by observating and having really interesting conversations. We guess the biggest difference between Malta and Finland is that the circulating nurse in Malta doesn’t have to do any documentation about the operation but only about the instruments and this is of course done by hand writing in Malta.
Part of our operating theatre placement we did in the recovery areas which were part of the operating theatre unit. The main recovery was for patients who went through the major operations and needed general anaesthesia in the most cases. The day recovery, smaller area than the main recovery, was for day surgery cases so the patients got home same day as the surgery was done.
The patient came to the recovery usually with the anaesthesia doctor and nurse who reported to the recovery nurse the important facts about the patient and the surgery done. First thing to do was to put the oxygen mask to the patient and only after that the pulse oximeter and blood pressure meter were connected. Documentation was done every five minutes to mark bloodpressure, oxygen saturation, pulse and other significant things such as patient’s responses to pain, touch and voice, nausea, bleeding etc. Usually the patients were monitored for half an hour in the day recovery and for one hour in the main recovery before they were transfered to ward or transfer area.
If there existed any complications in the recovery, the doctors were informed. Major bleeding or drop in bloodpressures and rise in pulse usually indicates internal bleeding which means that the operating area has to be reopened. Usual minor complications/side-effects such as nause and pain in the operating area were handled by giving medications subscribed by the anaesthesia doctor. Any given extra medications were documented to the post-op papers. Also, if the patient had drains in the operating area, they were checked extra carefully for any marks of bleeding.
To sum up: the operating theatre nurses’ work appeared to us really interesting and as a specific work where every nurse has their own special skills and knowledge. Like the doctors and surgeons every nurse has to do their part to support the team work and in that way create a system which the most important aim is to maintain the patient safety. In the recovery the nurse’s job is to secure patient’s basic needs- airway, breathing and circulation- and take care of any possible pain, nausea and bleeding. Also, waking up in the recovery can be very confusing for the patient so the nurse has to be alerted to respond the patient’s needs.
We really enjoyed this placement the most but we were also happy to end the long period of placements and enjoy the last week in Malta as deserved holiday;)
Tiia & Katariina