Dear Students: Southern Luzon State University College of Allied Medicine

SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE
NCM 12- Related Learning Course Description

Experience – Operating Room
The course deals with the concepts, principles, theories and techniques
of nursing care management of risk inflammatory and immunologic
response, cellular aberrations, acute and chronic. The learners are
expected to provide nursing care at risk and sick adult clients utilizing
the nursing process.
[Class schedule] 8 units-144 hours; RLE 6 units; Skills Lab-1 Unit-51 hours
RLE-5 units-255 hours
Monday/Saturday| 8:00-12:00; 1:00- 5:00

Tuesday: 8:00-12:00
Dear Students
This module is dedicated to the students of Southern
Luzon State University at College of Allied Medicine in
support to distant learning during this time of pandemic,
we hope that the students who read this book will prepare
you to shape your future in health care.
Corner Villa Aurea

Subdivision, Barangay
Domoit Lucena City 4301
0943 070 6995
lornacano11@gmail.com
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Ethico- Moral Responsibility: SPEAK OUT
Surgical Conscience Are You In or Out
Overview
NCM 112 RLE- Operating Room ( Focus Area) Prepared by: Dr. Lorna L. Cano, RN, RM; MAN– SY 2021-2022
Many patients enter and stays in the hospital days prior to operation. This enables the
patient to become familiar with the surroundings and to learn his role as a patient and what will be
expected of him/her. But, it must be remembered that each patient is a unique individual. H brings
to every situation a set of values, customs, expectations,, a code of behavior, and a manner of
communicating both verbally and non verbally.
Ethical values are essential for any healthcare provider. Ethics comes from the Greek word “ethos,”
meaning character. Ethical values are universal rules of conduct that provide a practical basis for
identifying what kinds of actions, intentions, and motives are valued. Ethics are moral principles
that govern how the person or a group will behave or conduct themselves. The focus pertains to the
right and wrong of actions and encompasses the decision-making process of determining the
ultimate consequences of those actions. Each person has their own set of personal ethics and
morals. Ethics within healthcare are important because workers must recognize healthcare
dilemmas, make good judgments and decisions based on their values while keeping within the laws
that govern them. To practice competently with integrity, nurses, like all healthcare professionals,
must have regulation and guidance within the profession.
The information provided in this module on peri-operative nursing ,the ethico-moral aspects in
nursing will give insights and right perspective as how an OR nurse works freely according to
nursing values and behaviors as to altruism, autonomy, with human dignity, integrity and social
justice to deliver nursing care based on the patient’s bill of rights
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Learning objectives
When you have studied this module, you are expected to:
1. Relate the concept of the expert nurse to nurses caring in the peri-operative, intra-operative and
immediate post -operative clients.
2. Identify the nursing roles of nurses assigned in the operating room as a scrub nurse and circulating
nurse.
3. Discuss the role of perioperative nurses in the quality of nursing care provided in different surgical
interventions.
4. Check the importance of values formation and values clarification in the management and treatment
of client underwent operation.
Discussion
The opportunities that I’ve had as a nurse are amazing. It is a great journey of my life of how I become
a significant person working as a nurse both in academe and in the clinical setting. A lot of experiences
happened that help and build me to become a leader in our accredited professional organization , a teacher
– learned the joy of helping to shape future nurses, a mother , a friend and most especially an advocate of
every persons who seek my tender, love and care as a truly nurse. I’d been working for almost 33 years
and assigned in different areas which gave me a challenging role ( worked in the Philippine Heart Center
assigned in PICU for 3 years , then in QMC, as clinical instructor – DR, OR, OPD, Med-Surg, EA ,OB-GYN,
Pedia,NICU, then in Cardinal Santos Medical Center,San Lazaro Hospital and National Center for Mental
Health. Why I need to share it with you all of this, because this experiences gave me and shape me
holistically and whole in delivering my nursing care in different aspect of nursing in delivering nursing care to
a needy individuals.
Despite of COVID 19 my perseverance to walk and follow the race of life that God’s assigned to me will be a
good start of how I will continue to serve and be a SERVANT to HUMANITY. I hope that every memories
that we shared as you read this module enlighten you to become a good servant of GOD in caring those
needy people. Be a river of hope and joy to our client by touching their lives with your HEALING HANDS,
CARING HEART, MIND FULL OF WISDOM, SOUL OF GRACE AND SPIRIT OF HOPE. GOD BLESS
EVERYONE…….
To make it easy and passionate for you to read this module , try to recall all the beautiful things or
memories happened in your life, while for the negative one ,turn on it into positive , in that way still you are
learning…. Life is beautiful……
We will discuss first the different ethical and moral principles to be learned wholeheartedly to avoid any
conflict as you deliver the nursing care to your clients. Then the role and functions of scrub nurse and
circulating nurse and other related topics in relation to values and behavior of perioperative nurses.
Description
Ethos
 comes from Greek work w/c means character/culture
 Branch of Philosophy w/c determines right and wrong
Moral
 personal/private interpretation from what is good and bad.
Ethical Principles:
1. Autonomy – the right/freedom to decide (the patient has the right to refuse despite the explanation of
the nurse) Example: surgery, or any procedure
2. Nonmaleficence – the duty not to harm/cause harm or inflict harm to others (harm maybe physical,
financial or social)
3. Beneficence– for the goodness and welfare of the clients
4. Justice – equality/fairness in terms of resources/personnel
5. Veracity – the act of truthfulness
6. Fidelity – faithfulness/loyalty to clients
Moral Principles:
1. Golden Rule
2. The principle of Totality – The whole is greater than its parts
3. Epikia – There is always an exemption to the rule
4. One who acts through as agent is herself responsible – (instrument to the crime)
5. No one is obliged to betray herself – You cannot betray yourself
6. The end does not justify the means
7. Defects of nature maybe corrected
8. If one is willing to cooperate in the act, no justice is done to him
9. A little more or a little less does not change the substance of an act.
10. No one is held to impossible
 Law – Rule of conduct commanding what is right and what is wrong. Derived from an Anglo-Saxon
term that means“that which is laid down or fixed”
 Court – Body/agency in government wherein the administration of justice is delegated.
 Plaintiff – Complainant or person who files the case (accuser)
 Defendant – Accused/respondent or person who is the subject of complaint
 Witness– Individual held upon to testify in reference to a case either for the accused or against the
accused.
Written orders of court
Writ – legal notes from the court
1. Subpoena
1. Subpoena Testificandum – a writ/notice to an individual/ordering him to appear in court at a
specific time and date as witness.
2. Subpoena Duces Tecum- notice given to a witness to appear in court to testify including all
important documents
2. Summon – notice to a defendant/accused ordering him to appear in court to answer the complaint
against him
3. Warrant of Arrest – court order to arrest or detain a person
4. Search warrant – court order to search for properties.
Public law
 body of law that deals with relationship between individuals and the State/government and
government agencies. Laws for the welfare of the general public.
Private/Civil Law
 body of law that deals with relationships among private individuals
Private/Civil Law
1. Contract law – involves the enforcement of agreements among private individuals or the payment of
compensation for failure to fulfill the agreements
 Ex. Nurse and client nurse and insurance
 Nurse and employer client and health agency
 An agreement between 2 or more competent person to do or not to do some lawful act.
 It maybe written or oral= both equally binding
Types of Contract:
1. Expressed –when 2 parties discuss and agree orally or in writing the terms and conditions during the
creation of the contract.
 Example: nurse will work at a hospital for only a stated length of time (6 months),under
stated conditions (as volunteer, straight AM shift, with food/transportation allowance)
2. Implied – one that has not been explicitly agreed to by the parties, but that the law considers to exist.
 Example: Nurse newly employed in a hospital is expected to be competent and to follow
hospital policies and procedures even though these expectations were not written or discussed.
 Likewise: the hospital is expected to provide the necessary supplies, equipment needed to
provide competent, quality nursing care.
Feature/Characteristics/Elements of a lawful contract:

1. Promise or agreement between 2 or more persons for the performance of an action or restraint from
certain actions.
2. Mutual understanding of the terms and meaning of the contract by all.
3. A lawful purpose – activity must be legal
4. Compensation in the form of something of value-monetary
Persons who may not enter into a contract: minor, insane, deaf, mute and ignorant
Tort law
 Is a civil wrong committed against a person or a person’s property.
 Person/person’s responsible for the tort are sued for damages
 Is based on:
 ACT OF COMMISSION –something that was done incorrectly
 ACT OF OMMISION – something that should have been done but was not.
Classification of Tort
Unintentional Tort
1. Negligence
 Misconduct or practice that is below the standard expected of ordinary, reasonable and prudent
person
 Failure to do something due to lack of foresight or prudence
 Failure of an individual to provide care that a reasonable person would ordinarily use in a similar
circumstance.
 An act of omission or commission wherein a nurse fails to act in accordance with the standard of
care.
Doctrines of Negligence:
1. Res ipsa loquitor – the thing speaks for itself – the injury is enough proof of negligence
2. Respondeat Superior – let the master answer command responsibility
3. Force majuere – unforeseen event, irresistible force
2. Malpractice
 stepping beyond one’s authority
6 elements of nursing malpractice:

1. Duty – the nurse must have a relationship with the client that involves providing care and following
an acceptable standard of care.
2. Breach of duty
 the standard of care expected in a situation was not observed by the nurse
 is the failure to act as a reasonable, prudent nurse under the circumstances
 something was done that should not have been done or nothing was done when it should
have been done
3. Foreseeability – a link must exist between the nurse’s act and the injury suffered
4. Causation – it must be proved that the harm occurred as a direct result of the nurse’s failure to follow
the standard of care and the nurse should or could have known that the failure to follow the standard of
care could result in such harm.
5. harm/injury –physical, financial, emotional as a result of the breach of duty to the client Example:
physical injury, medical cost/expenses, loss of wages, pain and suffering
6. damages – amount of money in payment of damage/harm/injury
Intentional Tort
 Unintentional tort – do not require intent bur do require the element of HARM
 Intentional tort – the act was done on PURPOSE or with INTENT
 No harm/injury/damage is needed to be liable
 No expert witnesses are needed
Assault
 An attempt or threat to touch another person unjustifiably
 Example:
 A person who threatens someone with a club or closed fist.
 Nurse threatens a client with an injection after refusing to take the meds orally.
Battery
 Willful touching of a person, person’s clothes or something the person is carrying that may or may
not cause harm but the touching was done without permission, without consent, is embarrassing or
causes injury.
 Example:
 A nurse threatens the patient with injection if the patient refuses his meds orally. If the nurse
gave the injection without client’s consent, the nurse would be committing battery even if the client
benefits from the nurse’s action.
False Imprisonment
 Unjustifiable detention of a person without legal warrant to confine the person
 Occurs when clients are made to wrongful believe that they cannot leave the place
 Example:
 Telling a client no to leave the hospital until bill is paid
 Use of physical or chemical restraints
 False Imprisonment Forceful Restraint=Battery
Invasion of Privacy
 intrusion into the client’s private domain
 right to be left alone
Types of Invasion the client must be protected from:
1. use of client’s name for profit without consent – using one’s name, photograph for advertisements of
HC agency or provider without client’s permission
2. Unreasonable intrusion – observation or taking of photograph of the client for whatever purpose
without client’s consent.
3. Public disclosure of private facts – private information is given to others who have no legitimate need
for that.
4. Putting a person in a false/bad light – publishing information that is normally considered offensive
but which is not true.
Defamation
 communication that is false or made with a careless disregard for the truth and results in injury to the
reputation of a person
Types:
1. Libel – defamation by means of print, writing or picture
1. Example:
2. o writing in the chart/nurse’s notes that doctor A is incompetent because he didn’t respond
immediately to a call
2. Slander – defamation by the spoken word stating unprivileged (not legally protected) or false word
by which a reputation is damaged
1. Example:
 Nurse A telling a client that nurse B is incompetent
 Person defamed may bring the lawsuit
 The material (nurse’s notes) must be communicated to a 3rd party in order that the
person’s reputation maybe harmed
Public Law:
Criminal Law – deals with actions or offenses against the safety and welfare of the public.
1. homicide – self-defense
2. arson- burning or property
3. theft – stealing
4. sexual harassment
5. active euthanasia
6. illegal possession of controlled drugs
A nurse must respect the dignity and value of patients and colleagues, and treat all persons equally
regardless of personal attributes or medical condition. Related to this is the responsibility to always respect
the patient's right to self-determination in her medical care.
Correctional nurse.net
Our profession as a nurse is guided by a strong set of laws and rules approved by the national
government for us to base our policies in. Nurses should be familiar with what these laws hold and
what they can do to help us function fully and legally and as an effective nurse in the hospital, in the
community or in any setting which our profession requires practice.
Standards of Administrative Nursing Practice:
Overview and Introduction What is a Code of Ethical Conduct? A Code of Ethical Conduct is a tool to help
create and maintain a culture of integrity. It is a set of rules that clearly and concisely outline the types of
behaviors that are expected in the workplace. Why is it important to have a Code of Ethical Conduct? A
Code of Ethical Conduct helps unite all of us by providing a set of expectations that we can all follow by
using the same behavioral standards. A Code of Ethical Conduct helps to create a safe, secure and healthy
work environment in which people are respected and valued as equal team members in the delivery of care.
To whom does the Code of Ethical Conduct apply? The Code of Ethical Conduct applies to all Board
members, executives and employees of Mount Sinai Hospital, including medical/professional staff, contract
staff, volunteers, students, researchers, Foundation and Auxiliary staff and all other employees. Without
exception, this Code applies equally to everyone at all levels in the organization. We also expect our
community partners to know and honor this Code. In order to create a positive work environment, all
members of Mount Sinai Hospital hold one another accountable for upholding this Code, which will be
posted on our intranet site. Specific provisions in collective agreements that do not align with this policy will
prevail. How will the Code be monitored? The Senior Management group of Mount Sinai Hospital has overall
responsibility for ensuring the implementation of the Code of Ethical Conduct within the Hospital. The Human
Resources Department is the executive owner of the Code. The Code is also overseen by the Code of
Ethical Conduct Advisory Committee.
Note: We use this for reference only, but still because we are using American textbook and we are a
part of International council of Nurses , the guidelines and policies are mostly the same. However, I
also included our own Philippine Nursing Code of Ethics
Operating Room Rationale.
As a professional association, the Association of Operating Room Nurses, Inc, believes measures must be
provided to judge the competency of its membership and to evaluate the quality of services rendered to
patients who experience surgical intervention.
Evidence that operating room nurses are seeking to control nursing practice in the operating room to protect
the public and the nurse is demonstrated through the development of standards. Standards are used as a
basic model to measure the quality of operating room nursing care. They are broad in scope, relevant,
attainable, and definitive. The administrative standards should be used in conjunction with existing
Standards of Nursing Practice: Operating Room‘ and the Standards of Technical and Aseptic Practice:
Operating Room established by AORN.*
The Standards of Nursing Practice: Operating Room are based on the nursing process and encompass
nursing activities directed toward preoperative assessment and preparation, intraoperative intervention, and
postoperative evaluation. Standards of Technical and Aseptic Practice are based on principles of
microbiology, validation in literature, and research, and are directed toward providing a safe operating room
environment for the patient
.
The “Standards of Administrative Nursing Practice: Operating Room” provide a basic model of structural
standards by which the quality of administration of the operating room may be evaluated. They serve as
guidelines for the development of a reliable means of providing good administrative care. Definition.
Administrative operating room nursing practice is the coordination of all functions relating to the nursing care
of patients experiencing surgical intervention.
The person charged with administrative responsibility in the operating room must be a registered nurse who
acquires management skills through education and experience. In addition, he or she must have experience
and expertise in operating room nursing.
Management skills encompass the ability to plan (determine in advance what should be done); organize
(determine where and in what sequence the work should be done); direct or activate the plan (apply human
force to the work); control (determine if the work has been done); and evaluate (appraise the care given).
Inherent in management is recognizing the balance between accomplishing the work and 1202 AORN
Journal, June 1976, Vol23, No 7 meeting human needs through effective interpersonal relations.
The administrator must possess leadership qualities and demonstrate flexibility, receptiveness, and the
ability to instill self confidence in others.
Standard 1. A philosophy and Objectives shall be formulated to guide the activities of the operating room. ~
Criteria
1. The philosophy is based on the philosophy of the institution
2. The philosophy reflects the meaning of nursing practice in
3. The objectives are measurable and are used to implement
4. The philosophy and objectives are in writing, widely distributed
5. The philosophy and objectives are periodically reviewed,
6. Operating room personnel share in the formulation, review, Standard 11. There shall be efficient
utilization of the operating suite and personnel. Criteria and nursing service. the operating room. the
philosophy. , and interpreted to all operating room personnel. revised, and updated. and revision of the
philosophy and objectives.
1. New staffing patterns are based on the type and number of procedures and the length of the
operation.
2. The staffing ratio of professional to nonprofessional workers insures direct professional nursing
supervision of patient care and application of aseptic technique at all times.
3. New staffing patterns are developed in consultation with the supervisors, assistants, and nursing and
hospital administration.
4. Operating room personnel are assigned to operative procedures based on their level of competence
and the specific needs of patients having operative procedures.
5. A plan is instituted when emergency surgery and extended procedures result in schedule delays. The
plan includes notification of appropriate personnel and units.
6. Operating room scheduling is coordinated with other hospital departments. These include, but are not
limited to: a. Recovery room and other nursing care units b. Laboratory c. X-ray
7. Personnel other than nurses are utilized in clerical, housekeeping, and other indirect service roles.
8. There is an ongoing evaluation of operating room utilization which includes, but is not limited to:
a. Type of case
b. Length of case
c. Time lapse between cases
d. Reason for delays
e. Length of operating room day (eg, 8 hours, 10 hours, 16 hours) AORN Journal, June 1976, Vol23, No 7
1203 Standard
111. Records and reports essential to providing safe care to surgical patients will be kept in the operating
room and utilized.
Criteria
1. Records of operations performed and daily case loads, and other records are used for: a. Statistical
information that includes, but is not limited to:
1) Members of OR team
2) Pre and postoperative diagnosis
3) Operative procedure
4) Length of time involved in the procedure b. Infection control (eg, breaks in technique) c.
Reference sources d. Legal documentations (eg, sponge, needle, and instrue. Budget
preparation
2. Recorded information is examined to assist in planning and organizing the operating room more
efficiently.
3. Records are used to provide information for reports (eg, annual report, yearly statistical reports, monthly
reports).
4. An operative record is kept that contains facts relating to the direct care of each patient and information
required by standard coding systems.
This includes, but is not limited to:

a. Patient's name
b. Patient's hospital number
c. Surgeon
d. Anesthesiologist
e. Assistant to surgeon
f. Preoperative diagnosis
g. Postoperative diagnosis
h. Scrub and circulating nurse
i. Operative procedure
j. Sponge, needle, and instrument counts
k. Wound status I. Specimen m. Complications
5. Reports are used as a method of communication for:
a. Minutes of operating room committee
b. Recording information that must be kept on file
c. Transmitting information on technique or practice
d. Announcing policy, rules, decisions, and meetings
6. The operating room administration collaborates with the medical records department in maintaining and
controlling the records required by the hospital and by legal statute.
Standard IV. The operating room shall have a budget that is used to plan, forecast, and control cost. Criteria
counts signed by a registered nurse)
1. The budget predicts the number and types of surgical procedures to be performed, the income
from these procedures, and the cost incurred in performing them. The procedures are influenced by, but not
limited to, the following factors:
a. New procedures anticipated 1204 AORN Journal, June 1976, Vol23, No 7
b. Surgical staffing changes c. Increases and decreases in hospital beds or types of
beds
2. The budget is periodically reviewed with:
a. Administration to be informed of overall budgetary limit. Operating room committee to
coordinate the use of procurement. Operating room staff to promote conscientiousness and
3. The budget is developed by, but not limited to, utilizing the or extensions of specialty supplies
and equipment understanding of financial requirements following:
a. Accounting facts and figures
b. Comparative monthly financial statements showing ac
c. Salary and wage adjustments
d. Allowance for supply cost increases
e. Innovations and projected technique changes
1. Standard depreciation factor of major equipment items
4. The objectives of nursing care are utilized as the determinant in forecasting the operating room
budget.
5. The budget is evaluated and revised as necessary to control expenditures. Standard V. A safe
operating room environment shall be established, controlled, and consistently monitored. Criteria
cost
1. Technical standards are established, maintained, and periodically reviewed.
These include, but are not limited to:
a. Sanitation
b. hospital packaging material
c. Sponge, needle, and instrument counts
d. OR wearing apparel
e. Draping and gowning materials
f. Preoperative skin preparation of patients
g. Surgical hand scrubs
a. Establish a baseline
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b. Monitor the environment

c. Investigate specific problems
3. Electrical safety is monitored periodically by adequately trained individuals and is consistent
with accepted regional, national, and hospital standards.
4. Potential explosive hazards are detected, reported, and eliminated by proper means.
5. Occupational safety for the employee is maintained by:
a. Provisions for first aid
b. Chest x-ray and immunization programs
c. Health insurance coverage
d. Safety programs and reviews
e. Radiation monitoring and protection
f. Proper body mechanics
g. Static electricity control
h. Proper scavenging systems for waste anesthetic gases 2. Bacteriological monitoring
is done to: AORN Journal, June 1976, Vol23, No 7 1205 i. Occupational Safety and
Health Administration (OSHA) regulation compliance
6. Physical facilities are maintained by:
a. Temperature control within acceptable ranges
b. Humidity control within acceptable ranges
c. Adequate air circulation and filtration systems
d. Proper maintenance of air filtering system
e. Fire alert systems
f. Constantly monitored steam system
g. Constantly monitored oxygen and other gas systems
h. Constantly monitored vacuum system
i. Adequate plumbing system
j. Automatic auxiliary power system
k. Security system utilized for operating room safety:
a. Governing boards
b. Licensing agencies
c. National Fire Protection Agency (NFPA)
d. Joint Commission on Accreditation of Hospitals (JCAH)
e. Occupational Safety and Health Administration (OSHA)
f. US Department of Health, Education, and Welfare (HEW)
Standard VI. The operating room shall have written policies and procedures that serve as operational
guidelines for the provisions of efficient and safe care to patients having surgery.
Criteria
1. Policies are written, dated, and enforceable.
2. Policies have the support of administration and/or the surgical committee
. 3. Personnel are informed and aware of the original purpose of the policy and its practical application.
4. Policies that become obsolete and not enforceable must be deleted from the policy manual.
5. Policies for the operating room shall include, but are not limited to:
a. Operative and special consents
1) Sterilization and abortion
2) Transplant
3) Supportive
4) General 7. Guidelines and regulations, established by the following, are and Medicare
b. Fire and disaster plans
c. Environmental control
d. Visitors and traffic control
e. Safety regulations but are not limited to:
a. Personnel policies
b. Hospital policies-rules and regulations
c. Operating room policy manual d. Operating room procedure book dated, and revised.
11
6. Policy and procedure manuals are available and include,

7. Policies and procedures are periodically reviewed, up1206 AORN Journal, June 1976, Vol23, No 7
8. Policies and procedures are interpreted to all operating
9. Procedures are used to: room personnel.
a. Set standards for appraisal
b. Produce predicatable outcomes
c. Analyze currently used methods
d. Standardize
e. Teach
f. Reduce errors and revision of policies and procedures. not limited to:
a. OR sanitation
b. Care and disposal of surgical specimens, cultures, and foreign bodies
c. Care of special equipment, including preventive maintenance contracts and records,
where necessary
d. Emergency action, eg, cardiac arrest
10. Operating room personnel share in the formulation, review,
11. Procedures for the operating room shall include, but are Standard VII. Staff development shall utilize
teaching-learning processes, and be constant and ongoing.
Criteria
1. Orientation programs are established and offered to all newly employed personnel. Content
includes, but is not limited to:
 a. Philosophy and objectives of institution, nursing service and operating
room
 b. Policies and procedures of practice
 c. Job descriptions d. Personnel policies
2. Regularly scheduled inservice programs are conducted for all personnel and include, but are
not limited to:
a. Periodic review of existing aseptic and nursing practices
b. Obtaining new knowledge and skills applicable to operating room nursing
c. Discussing problems and keeping personnel informed of changes in policies and
procedures in the hospital and department
3. Continued learning experiences are encouraged for individual practitioners to insure current
knowledge and practice.
5. Formal and informal counseling is employed, providing a climate for open communication,
 leading to employee development and satisfaction.
6. All interviews and counseling are documented, signed by the principals, and placed in the
 employee’s personnel file. 6. Provision is made for implementation of Standards of Nursing Practice:
Operating Room and other guidelines accepted by the profession.
7. Involvement in professional organizations and activities is encouraged including, but not limited to:
a. Reading professional journals
b. Participation in educational programs and meetings AORN Journal, June 1976, Vol23, No 7 1207
Notes
c. Colleague interchange
d. Application of knowledge gained. Standard VIII. Evaluation of employees, patient care, and
products shall be objective, ongoing, and according to preset criteria
. Criteria
1. Job descriptions and analyses are written, current, and approved by administration and/or the
personnel department. These are reviewed periodically and revised according to changing demands.
2. Employee performance reviews are conducted on a regular periodic basis, utilizing counseling
techniques and providing a climate for open communication leading to employee development.
3. Evaluation of operating room nursing practice is accomplished through various processes of
quality assurance, such as audit, peer review, and performance evaluation
. 4. Systematic investigations and problem solving are initiated and supported as methods by which
to improve patient care.
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5. Product evaluation includes, but is not limited to: a. Monitoring all products in use for defects and
inefficiencies and reporting serious malfunctions to purchasing and concerned industry for follow-up b.
Investigating new products c. Keeping accurate records of product evaluation d. Informing personnel of
changes resulting from evaluation 8. Encouraging personnel to participate in evaluations
6. Communication with industry is maintained to provide more effective service to the patient
through: a. Service and maintenance b. Education in use of supplies and equipment c. Quality control d.
Research and development of new products 1. Association of Operating Room Nurses and American
Nurses' Association Division on Medical-Surgical Nursing Practice, Standards of Nursing Practice: Operating
Room (Kansas City, Mo: American Nurses' Association, 1975). 2. "AORN Standards: OR wearing apparel,
draping and gowning materials," AORN Journal .21 (March 1975) 594-598; "AORN standards for OR
sanitation," AORN Journal 21 (June 1975) 1228- 1231 ; "Standards for sponge, needle, and instrument
procedures," AORN Journal 23 (May 1976) 971 ; "Standards for preoperative skin preparation of patients,"
AORN Journal 23 (May 1976) 974; "Standards for surgical hand scrubs," AORN Journal 23 (May 1976) 976;
"Standards for inhospital packaging materials," AORN Journal 23 (May 1976) 980. 1208 AORN Journal,
June 1976, Vol23, No 7
Code of Conduct Elmhurst Memorial Hospital, Elmhurst, Ill The behaviors summarized below define the
Code of Conduct for all employees of the Operating Room. The Code of Conduct, developed by the
Employee Satisfaction Committee and approved by the employees of the Operating Room, represents the
team work, work ethic and interpersonal relationships that are the goal of the Operating Room. Your
signature signifies that you agree to adhere to the positive behaviors outlined below. Furthermore, this
contract shall be used to clarify disputes and/or address problem or negative behaviors. POSITIVE
TEAMWORK BEHAVIORS
1. Arrives on time for work and prepared for work.
2. When not currently involved in a case, sets up/helps cases in other rooms without being asked. Helps
circulate in another room when his/her room is done.
3. Puts supplies/equipment away; keeps halls clear.
4. Checks with Charge RN when finished with assignment.
5. Timely follow through on projects/tasks/requests for information.
6. Actively participates on departmental committees.
7. Attends departmental meetings and in-services and shows respect for presenters by not talking during
presentations.
8. Tries to solve problems in most appropriate form, i.e.: one on one, via committees, department meetings.
9. Speaks positively about the department, the organization and the initiatives underway.
10. Demonstrates departmental and organizational support by providing timely feedback, constructive
criticism and/or recognition for positive efforts.
11. Attentive during surgery to the needs of the case, i.e.: gives supplies without prompting because he/she
is paying attention.
12. Utilizes Michael Cohen’s “Fair Fighting Techniques” to resolve conflict: · Asks for what you want in a
direct, honest and respectful manner. · Remain cool, calm and collected, and appropriately sets limits with
individual involved. · If it cannot be resolved at this level, 1) document the occurrence and 2) seek third party
assistance. · Do not take things personally.
13. Takes allotted time for lunch; does not stay beyond allotted time.
14. When given an assignment, maturely and professionally accepts and completes the assignment.
15. Able to work effectively with people they do not like and maintain effective communication.
16. States name when answering phone.
NEGATIVE TEAMWORK BEHAVIORS
1. Griping/dumping/gossiping/complaining before and after meetings.
2. Lodging a complaint about a co-worker and asking for anonymity about the complaint.
3. Gossiping and back-biting about co-workers, managers, etc.
4. Escalating negative situations by adopting bad behaviors, i.e.: yelling.
5. Hiding out in unused OR rooms, locker rooms and/or staff/MD lounges.
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6. Leaving the department without informing the Charge RN

7. When given an assignment, responds with one or more of the following: - Sighs, huffs - Refusing - Asking
what other staff are doing
8. Conducting inappropriate conversation in front of patients, including: · Complain that the case is too hard
· You are tired and/or don’t feel well · Your co-worker did not do something he/she was supposed to do ·
Making comments that are generally negative
9. Abandons the OR when someone comes in to help you.
10. Intentionally miscommunicates information about lunch requests.
11. Criticizes people publicly.
12. Demonstrates discourteous and unfriendly behavior to new people including telling new people “This
place is lousy”.
13. Complains and/or refuses an assignment.
14. Eats in front of patients in Holding Area, Front Desk.
15. Responds “I don’t know” without offering to find out/help.
16. Does not include patient in conversation, i.e.: speaks in a language patient does not understand,
discusses topics that are not related to the patient without including the patient in the conversation.
Positive Patient Care Behaviors

· Lets patient feel you have time for him/her; does not make patient feel rushed. ·
Greets patient in Holding Area; introduces self and answers questions. ·
Always prepared for case; does not wait until last minute to open case. ·
Takes responsibility for ensuring all supplies are available. ·
Takes responsibility for professional competence and skills. · Includes patient in conversations. ·
Cleans patients before sending to postanesthesia care unit (PACU). ·
Remains in the OR until the patient is off the table. ·
Treats patients with dignity and respect. ·
Makes eye contact with patient when patient enters the OR. ·
Keeps patient’s family updated. ·
Reassures patient he/she will receive excellent care. ·
Exhibits warm, caring behaviors, i.e. smiling, holding patient’s hand.
· Remains at bedside during induction. ·
Protects patient’s privacy. ·
Provides patient with warm blankets. ·
Keeps patient informed on what you are doing, what to expect. ·
Addresses patient by name. ·
Returns patient to room if surgery is delayed. ·
Notifies Charge RN of room delays to inform the patient, family and floor staff of change in scheduled time. ·
Calls Surgical Waiting Area at start of case. ·
Exchanges pleasantries with patient families if you see them outside OR/HA
. EFFECTIVE MANAGEMENT of PATIENT COMPLAINTS
Do: · Validate the complaint · Apologize as appropriate ·
Thank patient for bringing the problem to our attention. ·
Assure patient you “will bring this to the appropriate person.” · If cannot solve problem by self, get someone
who can. · Empathize with patient. · Summarize what patient said.
__________________________________________________ Date ______________ My signature
confirms that I have read the Positive Teamwork Behaviors contract and agree to comply with the behaviors,
to facilitate the development of a strong, teamwork-oriented and cooperative
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Code of Ethics for Nurses in the Philippines was devised as a guide for carrying out nursing
responsibilities which would tackle difficult issues and decisions that a profession might be facing, and
give clear instruction of what action would be considered ethical or right in the given circumstance.
The Code of Ethics for Registered Nurses in the Philippines is promulgated by the Board of Nursing
(BON) and was consulted with accredited professional organizations like the Philippine Nurses
Association. It also coincides with the ideals of Republic Act No. 9173 or the “Philippine Nursing Act
of 2002.”
The Code of Ethics for Filipino Nurses was made after a consultation on October 23, 2013 at Iloilo City
after accredited professional organizations decided to adopt a new Code of Ethics under the RA 9173.
Code of Ethics for Nurses in the Philippines | Nurseslabs
BOARD OF NURSING Board Resolution No. 220 Series of 2004 PROMULGATION OF THE CODE OF
ETHICS FOR REGISTERED NURSES WHEREAS, the Board of Nursing has the power to promulgate a
Code of Ethics for Registered Nurses in coordination and consultation with the accredited professional
organization (Sec. 9, (g), Art. III of R.A. No. 9173, known as the “Philippine Nursing Act of 2002);
WHEREAS, in the formulation of the Code of Ethics for Registered Nurses, the Code of Good Governance
for the Professions in the Philippines was utilized as the prinicipal basis therefor: All the principles under the
said Code were adopted and integrated into the Code of Ethics as they apply to the nursing profession;
WHEREAS, the promulgation of the said Code as a set of guidelines, regulations or measures shall be
subject to approval by the Commission (Sec. 9, Art. II of R.A. No. 9173); and WHEREAS, the Board, after
consultation on October 23, 2003 at Iloilo City with the accredited professional organization of registered
nurses, the Philippine Nurses Association, Inc (PNA), and other affiliate organizations of Registered Nurses,
decided to adopt a new Code of Ethics under the afore-mentioned new Law; NOW, THEREFORE, the Board
hereby resolved, as it now resolves, to promulgate the hereunder Code of Ethics for Registered Nurses:
ARTICLE I PREAMBLE SECTION 1. Health is a fundamental right of every individual. The Filipino registered
nurse, believing in the worth and dignity of each human being, recognizes the primary responsibility to
preserve health at all cost. This responsibility encompasses promotion of health, prevention of illness,
alleviation of suffering, and restoration of health. However, when the foregoing are not possible, assistance
towards a peaceful death shall be his/her obligation. SECTION 2. To assume this responsibility, registered
nurses have to gain knowledge and understanding of man’s cultural, social, spiritual, physiological,
psychological, and ecological aspects of illness, utilizing the therapeutic process. Cultural diversity and
political and socio-economic status are inherent factors to effective nursing care. SECTION 3. The desire for
the respect and confidence of clientele, colleagues, co-workers, and the members of the community provides
the incentive to attain and maintain the highest possible degree of ethical conduct. PRC-BN ARTICLE II
REGISTERED NURSES AND PEOPLE SECTION 4. Ethical Principles 1. Values, customs, and spiritual
beliefs held by individuals shall be respected. 2. Individual freedom to make rational and unconstrained
decisions shall be respected. 3. Personal information acquired in the process of giving nursing care shall be
held in strict confidence. SECTION 5. Guidelines to be observed: REGISTERED Nurses must a. consider
the individuality and totality of patients when they administer care. b. respect the spiritual beliefs and
practices of patients regarding diet and treatment. c. uphold the rights of individuals. d. take into
consideration the culture and values of patients in providing nursing care. However, in the event of conflicts,
their welfare and safety must take precedence. ARTICLE III REGISTERED NURSES AND PRACTICE
SECTION 6. Ethical Principles 1. Human life is inviolable. 2. Quality and excellence in the care of the
patients are the goals of nursing practice. 3. Accurate documentation of actions and outcomes of delivered
care is the hallmark of nursing accountability. SECTION 7. Guidelines to be observed: REGISTERED
Nurses must a. know the definition and scope of nursing practice which are in the provisions of R. A. No.
9173, known as the “Philippine Nursing Act of 2002” and Board Res. No. 425, Series of 2003, the “Rules and
Regulations Implementing the Philippine Nursing Act. of 2002”, (the IRR). b. be aware of their duties and
15
responsibilities in the practice of their profession as defined in the “Philippine Nursing Act of 2002” and the
IRR. c. acquire and develop the necessary competence in knowledge, skills, and attitudes to effectively
render appropriate nursing services through varied learning situations. PRC-BN d. if they are administrators,
be responsible in providing favorable environment for the growth and developments of Registered Nurses in
their charge. e. be cognizant that professional programs for specialty certification by the BON are accredited
through the Nursing Specialty Certification Council (NSCC). g. see to it that quality nursing care and practice
meet the optimum standard of safe nursing practice. h. insure that modification of practice shall consider the
principles of safe nursing practice. i. if in position of authority in a work environment, be normally and legally
responsible for devising a system of minimizing occurrences of ineffective and unlawful nursing practice. j.
ensure that patients’ records shall be available only if they are to be issued to those who are professionally
and directly involved in their care and when they are required by law. SECTION 8. Ethical Principle 4.
Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard their
rights and privileges. Guidelines to be observed: REGISTERED Nurses must a. respect the “Patients’ Bill of
Rights” in the delivery of nursing care. b. provide the patients or their families with all pertinent information
except those which may be deemed harmful to their well-being. c. uphold the patients’ rights when conflict
arises regarding management of their care. SECTION 10. Ethical Principle 5. Registered Nurses are aware
that their actions have professional, ethical, moral, and legal dimensions. They strive to perform their work in
the best interest of all concerned. SECTION 11. Guidelines to be observed: REGISTERED Nurses must: a.
perform their professional duties in conformity with existing laws, rules regulations. measures, and generally
accepted principles of moral conduct and proper decorum. b. not allow themselves to be used in
advertisement that should demean the image of the profession (i.e. indecent exposure, violation of dress
code, seductive behavior, etc.). c. decline any gift, favor or hospitality which might be interpreted as
capitalizing on patients. d. not demand and receive any commission, fee or emolument for recommending or
referring a patient to a physician, a co-nurse or another PRC-BN health care worker; not to pay any
commission, fee or other compensations to the one referring or recommending a patient to them for nursing
care. e. avoid any abuse of the privilege relationship which exists with patients and of the privilege access
allowed to their property, residence or workplace. ARTICLE IV REGISTERED NURSES AND CO-
WORKERS SECTION 12. Ethical Principles 1. The Registered Nurse is in solidarity with other members of
the healthcare team in working for the patient’s best interest. 2. The Registered Nurse maintains collegial
and collaborative working relationship with colleagues and other health care providers. SECTION 13.
Guidelines to be observed: REGISTERED Nurses must a. maintain their professional role/identity while
working with other members of the health team. b. conform with group activities as those of a health team
should be based on acceptable, ethico-legal standards. c. contribute to the professional growth and
development of other members of the health team. d. actively participate in professional organizations. e. not
act in any manner prejudicial to other professions. f. honor and safeguard the reputation and dignity of the
members of nursing and other professions; refrain from making unfair and unwarranted comments or
criticisms on their competence, conduct, and procedures; or not do anything that will bring discredit to a
colleague and to any member of other professions. g. respect the rights of their co-workers. ARTICLE V
REGISTERED NURSES, SOCIETY, AND ENVIRONMENT SECTION 14. Ethical Principles 1. The
preservation of life, respect for human rights, and promotion of healthy environment shall be a commitment
of a Registered Nurse. 2. The establishment of linkages with the public in promoting local, national, and
international efforts to meet health and social needs of the people as a contributing member of society is a
noble concern of a Registered Nurse. SECTION 15. Guidelines to be observed: REGISTERED Nurses must
a. be conscious of their obligations as citizens and, as such, be involved in community concerns. PRC-BN b.
be equipped with knowledge of health resources within the community, and take active roles in primary
health care. c. actively participate in programs, projects, and activities that respond to the problems of
society. d. lead their lives in conformity with the principles of right conduct and proper decorum. e. project an
image that will uplift the nursing profession at all times. ARTICLE VI REGISTERED NURSES AND THE
PROFESSION SECTION 16. Ethical Principles: 1. Maintainance of loyalty to the nursing profession and
preservation of its integrity are ideal. 2. Compliance with the by-laws of the accredited professional
organization (PNA), and other professional organizations of which the Registered Nurse is a member is a
lofty duty. 3. Commitment to continual learning and active participation in the development and growth of the
profession are commendable obligations. 4. Contribution to the improvement of the socio-economic
conditions and general welfare of nurses through appropriate legislation is a practice and a visionary
16
mission. SECTION 17. Guidelines to be observed: Registered Nurses must a. be members of the Accredited
Professional Organization (PNA). b. strictly adhere to the nursing standards. c. participate actively in the
growth and development of the nursing profession. d. strive to secure equitable socio-economic and work
conditions in nursing through appropriate legislation and other means. e. assert for the implementation of
labor and work standards. ARTICLE VII ADMINISTRATIVE PENALITIES, REPEALING CLAUSE, AND
EFFECTIVITY SECTION 18. The Certificate of Registration of Registered Nurse shall either be revoked or
suspended for violation of any provisions of this Code pursuant to Sec. 23 (f), Art. IV of R. A. No. 9173 and
Sec. 23 (f), Rule III of Board Res. No. 425, Series of 2003, the IRR. SECTION 19. The Amended Code of
Ethics promulgated pursuant to R. A. No. 877 and P.D. No. 223 is accordingly repealed or superseded by
the herein Code. SECTION 20. PRC-B
Overview
Perioperative nursing describes the wide variety of nursing functions associated with the patient’s surgical
management. It has three phases of the surgical experience namely:
1. Preoperative phase. This phase begins when the decision for surgical intervention is made and ends
when the patient is transferred from the operating room.
2. Intraoperative phase. This phase begins when the patient is admitted or transferred to the surgery
department and ends when he or she is admitted to the recovery area.
3. Postoperative phase. This phase begins with the admission of the patient to the recovery area and
ends with a follow-up evaluation in the clinical setting or at home.
Preoperative Phase of the Surgical Experience
The patient who consents to have surgery, particularly surgery that requires a general anesthetic, renders
himself dependent on the knowledge, skill, and integrity of the health care team. In accepting this trust, the
health care team members have an obligation to make the patient’s welfare their first consideration during
the surgical experience.
The scope of activities during the preoperative phase includes the establishment of the patient’s baseline
assessment in the clinical setting or at home, carrying out preoperative interview and preparing the patient
for the anesthetic to be given and the surgery.
Goals during the Preoperative Phase
Although the physician is responsible for explaining the surgical procedure to the patient, the patient may ask
the nurse questions about the surgery. There may be specific learning needs about the surgery that the
patient and support persons should know. A nursing care plan and a teaching plan should be carried out.
During this phase, emphasis is placed on:
 Assessing and correcting physiological and psychological problems that may increase surgical risk.
 Giving the patient and significant others complete learning and teaching guidelines regarding the
surgery.
 Instructing and demonstrating exercises that will benefit the patient postoperatively.
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 Planning for discharge and any projected changes in lifestyle due to the surgery.
Prepare before you get to the OR by knowing the patient thoroughly and having a basic understanding of
what is planned. Avoid stereotyping the nurses as “cranky,” the surgeons as “egotistical,” and the medical
students as “clueless” by learning the OR routine. Be alert, attentive, and, above all, patient. Don’t be afraid
to admit to the scrub nurse and the circulating nurse that you’re new in the OR. They are usually happy to
help you follow correct procedures.
In the OR everything is geared toward maintaining a sterile field. Use of sterile technique begins in the locker
room. Change into scrub clothing. Remove your T-shirt, tuck the scrub shirt into the pants, and tuck the ties
of the scrub pants inside the pants. In some hospitals scrub clothes are allowed on the wards, provided they
are covered by a coat or other form of gown; check your hospital’s requirements.
This is the common scenario that we see in the operating room…….. are you interested to be a scrub nurse
and a circulating nurse…… so try to assimilate the heart of serving and saving the life of our patients. Be
responsible in learning the DO and DON’T’S in Operating Room. WHO ARE THEY…… AND SOON TO BE
YOU.
Scrub nurse
Is a specially trained nurse who works with surgeons and medical team in the operating room. Scrub nurses
are extremely valuable members of the surgical team, providing support in the operating room and patient
care outside of it as well. This career can be very demanding, but also quite rewarding, and careers in
nursing are constantly expanding due to the rising need for these crucial health care professionals. Some
scrub nurses even become highly sought after members of surgical team, especially experienced scrub
nurses who are familiar with a wide range of procedures.
Scrub nurses are more formally known as perioperative nurses. Perioperative nursing involves patient care
before , during, and after surgery. There are a number of different preoperative nursing positions; the scrub
nurse is actually fulled “ scrubbed in” for the surgery, meaning that he or she has used special soaps and
wears sterile garments so that the nurse can work next to the operative field. A scrub nurse hands
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instruments to the surgeon and helps to keep an eye on the patient’s condition. Scrub nurses are also
familiar with the operation of emergency room equipment.
Duties of a Scrub Nurse> the duties of a scrub nurse may not seem that difficult to individuals looking at
surgery from the outside…What are the duties of the Scrub Nurse during Surgery?
Before an Operation
1. Ensures that the circulating nurse checked the equipment.

2. Ensures that the theater has been cleaned before the trolley is set.
3. Prepares the instruments and equipment needed in the operation.
4. Uses sterile technique for scrubbing, gowning and gloving.
5. Receives sterile equipment via circulating nurse using sterile technique.
6. Performs initial sponges, instruments and needle count, checks with circulating nurse.
When surgeon arrives after scrubbing
1. Perform assisted gowning and gloving to the surgeon and assistant surgeon as soon as they
enter the operation suite.
2. Assemble the drapes according to use. Start with towel, towel clips, draw sheet and then lap
sheet. Then, assist in draping the patient aseptically according to routine procedure.
3. Place blade on the knife handle using needle holder, assemble suction tip and suction tube.
4. Bring Mayo stand and back table near the draped patient after draping is completed.
5. Secure suction tube and cautery cord with towel clips or allis.
6. Prepares sutures and needles according to use.
7. Maintain sterility throughout the procedure.
8. Awareness of the patient’s safety.
9. Adhere to the policy regarding sponge count/ instruments count/ surgical needles.
10. Arrange the instrument on the mayo table and on the back table.
Before the Incision Begins
1. Provide 2 sponges on the operative site prior to incision.

2. Passes the 1st knife for the skin to the surgeon with blade facing downward and a hemostat to the
assistant surgeon.
3. Hand the retractor to the assistant surgeon.
4. Watch the field/s procedure and anticipate the surgeon’s needs .
5. Pass the instrument in a decisive and positive manner.
6. Watch out for hand signals to ask for instruments an keep instrument as clean as possible by wiping
instruments with moist sponge.
7. Always remove charred tissue from the cautery tip.
8. Notify circulating nurse if you need additional instruments as clear as possible.
9. Keep 2 sponges on the field.
10. Save and care for tissue specimen according to the hospital policy.
11. Remove excess instrument from the sterile field.
12. Adhere and maintain sterile technique and watch for any breaks .
End of Operation
1. Undertake count of sponges and instruments with circulating nurse.
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2. Informs the surgeon of count result.

3. Clears away instrument and equipment.
4. After operation: helps to apply dressing.
5. Removes and siposes of drapes.
6. De-gown.
7. Prepares the patient for recovery room.
8. Completes documentation.
9. Hand patient over to recovery room.
Role of Scrub Nurse
1. Works directly with surgeon within the sterile field, passing instruments , sponges and other items
needed during the procedure.
2. Members of the surgical team who prepares and preserves a sterile field in which the operation can
take place.
3. Responsible for the sponge counts, the blades and needles and instruments check throughout the
operation.
4. Has a job requiring anticipation, quick reaction and conscientious observation as well as knowledge
of anatomy and the operative procedures.
CIRCULATING NURSE
A circulating nurse, another type of operating room (OR) nurse, works on the perimeter of the operating
room, monitoring patient care, ensuring that the room stays sterile, and keeping track of instruments and
sponges. Perioperative nurses also help to prepare patients for surgery, and they provide valuable care and
monitoring for patients when do the cutting, but a scrub nurse is every bit as important.
Circulating Nurse
picture
1. Sends for patient.

2. Visits with patient preoperatively: verifies operative permit, identifies patient, and answer questions.
3. Performs patient assessment.
4. Checks medical record.
5. Assists in transfer of patient.
6. Positions patient on operating table.
Role of Circulating Nurse
Responsibilities include but are not limited to:
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1. Management of personnel, equipment, supplies, and environment during surgical procedure.

2. Patient care including assessment, assisting the anesthesia team, positioning, prepping, and
documentation.
3. Manages flow of information and supplies to and from the surgical team members scrubbed at the
field.
Before an operation:
1. Checks all equipment for proper functioning such as cautery machine, suction machine, OR light and
OR table.
2. Make sure theater is clean.
3. Arrange furniture according to use.
4. Place a clean sheet, arm board (arm strap) and a pillow on the OR table.
5. Provide a clean kick bucket and pail.
6. Collect necessary stock and equipment.
7. Turn on aircon unit.
8. Help scrub nurse with setting up the theater .
9. Assist with counts and records.
During the Induction of anesthesia
1. Turn on OR light.
2. Assist the anesthesiologist in positioning the patient.
3. Assist the patient in assuming the position for anesthesia.
4. Anticipate the anesthesiologist’s needs.
5. If spinal anesthesia is contemplated.
After the patient is anesthetized
1. Reposition the patient per anesthesiologist’s instruction.

2. Attached anesthesia screen and place the patient’s arm on the arm boards.
3. Apply restraints on the patient.
4. Expose the area for skin preparation.
5. Catheterize the patient as indicated by the anesthesiologist.
6. Perform skin preparation.
During Operation
1. Remain in theater throughout the operation.

2. Focus the OR light every now and then.
3. Connect diatherapy, suction, etc.
4. Position kick buckets on the operating side.
5. Replenishes and records sponge/sutures.
6. Ensure the theater door remain closed and patient’s dignity is upheld.
7. Watch out any break in aseptic technique.
End of Operation
1. Assist with final sponge and instruments count.
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2. Signs the theater register.

3. Ensures specimen are properly labeled and signed.
After an Operation
1. Hands dressing to the scrub nurse.

2. Helps remove and dispose of drapes.
3. Helps to prepare the patient for the recovery room.
4. Assist the scrub nurse, taking the instrumentations to the service. ( service room).
5. Ensures that the theater is ready for the next case.
Nursing Roles
Circulating Nurse:
1. Deal with the management of unsterile

activities in the operating area.
2. Document the nursing care of the patient
- Assessments
- Interventions
3. Movements of unsterile items out of the
surgical suite
- Labeling and transporting specimens
slideshare,net
Scrub Nurse
1. Is gowned and gloved and able to

handle and pass sterile items into
the sterile surgical field.
2. “Boss” of the sterile field.
3. Assists with the actual procedure to
varying degrees.
opnews.com
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Circulating Nurse is a type of surgical nurse who circulates in the operating room to monitor the
procedure. He or she acts as a patient advocate ensuring that the conditions in the operating room remain
safe and sterile. Circulating nurses also performs wide variety of other tasks, which range from helping to set
up the operating room for surgery to filling out paper works which pertains to the surgery. This nursing career
requires a very fine attention to detail, and a lot of stamina, as circulating nurses must be present and active
throughout surgery.
Role of Circulating Nurse
1. Responsible for managing the nursing care of the patient within the OR and coordinating the needs
of the surgical team with other care provider necessary for completion of surgery.
2. Observes the surgery and surgical team from broad perspective and assists the team to create and
maintain safe and comfortable environment for the patient.
3. Assess the patient’s condition before, during, and after operation to ensure an optimal outcome for
the patient.
4. Must be able to anticipate the scrub nurse’s needs and be able to open sterile packs, operate
machinery and keep accurate records.
Coordination
In an operating room, there are two area:
1. The sterile operating field

2. The nonsterile area
During surgery , the goal is to keep the operating field totally sterile for patient safety. Circulating nurses
monitor the sterile field, informing operating room staff when something might compromise the sterility.
They also connect the people in the sterile field with the nonsterile area. For example, a circulating nurse can
open an autoclaved packaged so that someone in the operating field can access the sterile tool inside.
The other type of surgical nurse is a scrub nurse , a nurse who scrubs in so that he or she can work in the
surgical field, assisting the surgeon. Scrub nurses also monitor patient safety and he safety of the sterile field
while acting as assistants to the surgeon, and they generally work closely with the circulating nurse
throughout the procedure. Keeping lines of communication within the surgical team open is critical, so that
emergent problems can be quickly and professionally addressed.
Because the circulating nurse works in the non sterile field, this member of the surgical team does not need
to be sterile. For patient safety, however, the circulating nurse and other staffers in the nonsterile area
usually wear masks, keep their hair contained under surgical caps, and take other measures to avoid
compromising the clean conditions in the operating room.
The scrub surgical technologist handles the instruments supplies and equipment necessary during the
surgical procedure. He/she has an understanding of the procedure being performed and anticipates the
needs of the surgeon. He/she has the necessary knowledge and ability to ensure quality patient care during
the operative procedures and is constantly on vigil for maintenance of the sterile field. Duties are as follows:
1. Checks supplies and equipment needed for surgical procedure.

2. Scrubs, gowns, and gloves.
3. Sets up sterile table with instruments, supplies, equipment and medications/solutions needed for
procedure.
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4. Performs appropriate counts with circulator prior to the operation and before incision is closed..
5. Gowns and gloves surgeon and assistants.
6. Helps in draping sterile field.
7. Passes instruments, etc. to surgeon during procedure.
8. Maintains highest standard of sterile technique during procedure.
9. Prepare sterile dressings.
10. Cleans and prepares instruments for terminal sterilization.
11. Assists other members of team with terminal cleaning of room.
12. Assists in prepping room for the next patient.
Circulating surgical Technologist
The surgical technologist-assisting in circulating obtains additional instruments, supplies, and equipment
necessary while the surgical procedure is in progress. He/she monitors conditions in the operating room and
constantly assesses the needs of the patient and surgical team. Duties are as follows:
1. Obtains appropriate sterile and unsterile items needed for procedure.

2. Opens sterile supplies.
3. Checks patient’s chart, identifies patient, verifies surgery to be performed with consent forms, and
brings patient to assigned operating room.
4. Transfers patient to operating room.
5. Assesses comfort and safety measures and provides verbal and tactile reassurance to the patient.
6. Assists anesthesia personnel.
7. Positions patient, using appropriate equipment.
8. Applies electrosurgical grounding pads, tourniquets , monitors, etc., before procedure begins.
9. Prepares the patient’s skin prior to draping by surgical team.
10. Performs appropriate counts with scrub person prior to the operation and before incision is closed.
11. Anticipates additional supplies needed during the procedure,
12. Keeps accurate records throughout the procedure.
13. Properly cares for the specimens.
14. Secures dressing after incision closure.
15. Helps transport patient to recovery room.
16. Assist in cleaning of room and preparing for the next patient.
One of the most critical job that the OR nurse can do is the documentation. I will give you a sample of how
FDAR documentation was written and done in the Operating Room. As what we discussed the word “ Res
Ipsa Loquitor “. Here’s the sample:
Received a 17 year old female. Conscious and coherent, with ongoing IVF of D%LR 1L
inserted at right metacarpal vein, approximately 900 cc regulated at 31 gtts per minute infusing well.
With complaint of ruptured of BOW for 2 days. For CS. Consent verified through chart and asking
patient for her signature affix in the chart. Patient under legal age Consent verified through SO. No
known allergies. Pre op checklist completed. Ushered to OR. Hooked to monitor vital signs as follows.
Hooked to O2 via nasal cannula/facemask at 6LPM Sign in performed. Reposition to lateral Lumbar,
prep done. For Spinal anesthesia/ general anesthesia induce by DR…. Reposition to supine . Arm straps
applied for safety. Baseline counting performed in the presence of circulating Nurse MR.. Operative site
prep done. Operation started by DR M.. assited by DR Z... Via midline incision. Incision deepened to
peritoneum. Uterus incised. Baby boy/girl delivered. Placenta delivered followed by thourough
evacuation of uterine blood clots. Uterus sutured layer by layer. ( If with BTL ) bilateral tubal ligation
done. For histopath. Initial counting of needles sponges and instruments done and reported complete.
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Final counting of same done, with complete count. Operation ended. Post op care done. VS as follows.
… Sign out performed. Transferred to stretcher. Brought to PACU and endorsed accordingly.
Signature of the Nurse ( Circulating Nurse)
Evaluation
1.DISCUSS THE ROLE OF CIRCULATING AND SCRUB NURSE.
2. Based on this sample chart. Make a complete details using FDAR documentation
Reference:
AORN Journal, June 1976, Vol23, No 7
RNPedia BOARD OF NURSING Board Resolution No. 220 Series of 2004 PROMULGATION OF THE
CODE OF ETHICS FOR REGISTERED NURSES.Copyright 2020
Lisa M. Haddad; Robin A. Geiger. Ethico-Moral Aspects in Nursing. Feb. 2020
https://www.slideshare.net/vijayvandali/scrub-and-circulating-nurse
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Dear Students: Southern Luzon State University College of Allied Medicine

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Dear Students: Southern Luzon State University College of Allied Medicine

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SOUTHERN LUZON STATE UNIVERSITY

COLLEGE OF ALLIED MEDICINE

NCM 12- Related Learning Course Description

Monday/Saturday| 8:00-12:00; 1:00- 5:00

Corner Villa Aurea

0943 070 6995

Surgical Conscience Are You In or Out

Feature/Characteristics/Elements of a lawful contract:

6 elements of nursing malpractice:

Standards of Administrative Nursing Practice:

Operating Room Rationale.

This includes, but is not limited to:

b. Monitor the environment

6. Policy and procedure manuals are available and include,

6. Leaving the department without informing the Charge RN

Positive Patient Care Behaviors

Preoperative Phase of the Surgical Experience

Goals during the Preoperative Phase

1. Ensures that the circulating nurse checked the equipment.

When surgeon arrives after scrubbing

Before the Incision Begins

1. Provide 2 sponges on the operative site prior to incision.

1. Undertake count of sponges and instruments with circulating nurse.

2. Informs the surgeon of count result.

Role of Scrub Nurse

1. Sends for patient.

Role of Circulating Nurse

Responsibilities include but are not limited to:

1. Management of personnel, equipment, supplies, and environment during surgical procedure.

During the Induction of anesthesia

After the patient is anesthetized

1. Reposition the patient per anesthesiologist’s instruction.

1. Remain in theater throughout the operation.

1. Assist with final sponge and instruments count.

2. Signs the theater register.

1. Hands dressing to the scrub nurse.

1. Deal with the management of unsterile

1. Is gowned and gloved and able to

Role of Circulating Nurse

In an operating room, there are two area:

1. The sterile operating field

1. Checks supplies and equipment needed for surgical procedure.

Circulating surgical Technologist

1. Obtains appropriate sterile and unsterile items needed for procedure.

Signature of the Nurse ( Circulating Nurse)

1.DISCUSS THE ROLE OF CIRCULATING AND SCRUB NURSE.

AORN Journal, June 1976, Vol23, No 7

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