Operating Room

Introduction:
The operating room is a complex environment in which
individual team members perform specific tasks according to
their role. The operating room can be a very intimidating
environment. Becoming familiar with various operating room
personnel, equipment and workflow, as well as understanding
proper etiquette and safety precautions, is of upmost importance
to becoming comfortable in the operating room environment.
The patient who is entering the operating room is maybe solving
a health problem or for a diagnostic purpose. There is a simple
surgical operation that does not require any preparation before
the operation like:
 Breast biopsy.
 Arthroscopy.
 Laparoscopy.
 Burn excision and debridement procedures.

And there is a complex surgical operation that requires

preparation before the operation like:
 Separation of Conjoined Twins
 Spinal Osteomyelitis Surgery.
 Spinal Osteomyelitis Surgery.
 Spinal Osteomyelitis Surgery.
During my working period in the hospital, a patient was
entered to the hospital for lumbar spine fixation surgery
Which is Spinal fusion permanently connects two or more
vertebrae in the spine to improve stability, correct a deformity
or reduce pain. Lumbar spine fixation surgery used to treat
Spinal weakness or instability. This patient had a terrible
 problem in his spine therefore; the doctor performed a lumbar
spine fixation surgery to his spine because his spine became
unstable if there's abnormal or excessive motion between two
vertebrae. This is a common side effect of severe arthritis in
the spine. Spinal fusion can be used to restore spinal stability.
The patient's name abdalazem abdalgany abd aslam and his
age was 61 years and 8 month and the date of the surgery was
2022-5-16 at 1:30 pm
The members of the operation theater team which are the
surgeon, anesthesiologist, and the scrub nurse who is called
aslam and circulating nurse, also the anesthesia nurse prepared
the patient to perform lumbar spine fixation surgery.

The description of the operating theatre:

The operating room (OR) is a sterile, organized environment.
As a health care provider, you may be required to enter the
OR during a surgical procedure or to set up before a surgical
procedure. It is important to understand how to enter an OR
area and how the OR area functions to maintain an sterile
environment.
Members of the surgical team work hard to coordinate their
efforts to ensure the safety and care of their patients. The
surgical team is in charge of the OR and makes decisions
regarding patient care procedures. The OR environment has
sterile and non-sterile areas, as well as sterile and non-sterile
personnel. It is important to know who is sterile and who
not, and which areas in the OR are sterile or non-sterile.
STERILE OR PERSONNEL
 Surgeon
 Surgical assistant
  Scrub nurse
NON-STERILE OR PERSONNEL

 Anesthesiologist
 Circulating nurse
 Technologist, student, or observer

There are specific requirements for all health care professionals

entering the OR to minimize the spread of microorganisms and
maintain sterility of the OR environment. The members of the
operating room were wearing surgical clothes and these may
include:
 A protective cap covering their hair
 Masks covering their mouths and noses
 Shades or glasses over their eyes
 Gloves on their hands
 Long gowns over their clothes
 Protective covers on their shoes

Other infection control precautions like:

❖Surgical hand scrub
❖Maintaining an aseptic environment throughout the
procedure
❖Proper handling of the instruments
This is done to prevent patients and health workers from being
harmed by avoidable infection and as a result of antimicrobial
resistance. The area that I worked at when I was in the hospital
contains 6 operation rooms and also there is a recovery room
that contains all necessary equipment required in the post
anesthesia immediate care phase. The patient during the
lumbar spine fixation surgery was in prone position

The actual role of the nurse in the clinical area:

The role of the nurse in this clinical area is divided into 4
phases:
❖ Preoperative care
❖ Intraoperative care
❖ Post-anesthesia immediate care
❖ Post-operative care
Also, there are 3 types of nurses which are:
❖Scrub nurse
❖Anesthesia nurse
❖Circulating nurse
The actual role of a scrub nurse was:
Before surgery:
The scrub nurse’s duties begin far before the start of the
operation. He ensures the operating room is clean and ready to
be set up, then prepares the instruments and equipment needed
for the surgery. He counts all sponges, instruments, needles and
other tools and preserves the sterile environment by “scrubbing
in,” which requires washing his hands with special soaps and
putting on sterile garments, including a gown, gloves and face
mask. When the surgeon arrives, the nurse helps her with her
gown and gloves before preparing the patient for surgery.

During surgery:

During the operation, one of the scrub nurse’s primary duties is

selecting and passing instruments to the surgeon. The scrub
nurse’s role here is supporting the surgeon while also
maintaining patient safety. The nurse must know which
instruments are used for specific procedures and when they are
needed, so she can quickly hand them to the surgeon. The
scrub nurse must also watch for hand signals to know when the
surgeon is ready for the next tool or when he is done using a
tool and is ready to hand it back to the scrub nurse, who cleans
the tools after use and places each tool back in its place on the
table. She also monitors the surgery to ensure everything
remains sterile.

After surgery:

After the operation, the scrub nurse again counts all

instruments, sponges and other tools and informs the surgeon
of the count. He removes tools and equipment from the
operating area, helps apply dressing to the surgical site and
transports the patient to the recovery area. He also completes
any necessary documentation regarding the surgery or the
patient's transfer to recovery.

The actual role of the circulating nurse was ;

In the operating room, the duties of the circulating nurse are

carried out outside the sterile area. The RN Circulator manages
all the necessary care inside the surgery room, assisting the
team in maintaining and creating a comfortable, safe
environment for the patient and observing the team from a
wide perspective. He or she must ensure all surgical team
members perform in a unified effort. During operation, most
patients are sedated or anesthetized and so, they are
powerless to decide on their own. By using assessment,
diagnosing, critical thinking, and planning skills, the circulating
nurse can direct care and the activities of the team for the
patient’s best interest.

The duties of the circulating nurse are;

 Patient Safety – every patient deserves a trained, skilled

and knowledgeable RN in the surgery room, assuming the
role as patient advocate – the primary spokesperson of
the patient
 Skillful clinical judgment– observation, knowledge, and
assessment skills along with the ability to foresee needs
are essential to the success of the operation. This
attribute is also an imperative component when making
decisions in behalf of the patient.

 Informed Monitoring – the circulating nurse serves the

welfare of the patient including the team’s success by
assuming the role of an active observer, carefully
watching any unintended or unanticipated event that
could compromise the patient.

 Critical thinking –as the patient’s guardian in the

operating room, it is the nurse circulator’s job to perform
an accurate recording, interpretation and response to the
stream of data that is present during the course of
operation
 Accurate assessment – the education, training, and
unwavering commitment to the patient allows the RN
circulator to respond appropriately and quickly to the
patient’s psychological, social and biological health.

 Interpersonal communication skills –possessing a mix of

proficiency, perception, and professionalism, these
components defines a circulating nurse’s ability to
interact and collaborate with all members of the team,
which results to high quality level of care provided to the
patient.
 Expert evaluation –a circulating nurse is trained to
perform accurate decision-making and perception,
allowing not only sound assessment of the patient’s
condition but also capable in planning, implementing, and
evaluating patient care. 

The ideal role of the nurse in the clinical area:

The ideal role of the scrub nurse in addition to the roles
that I mentioned above is:

❖ Counts all sponges, instruments, needles, and other

tools

❖ Supports the surgeon while also maintaining patient

safety

❖ Removes tools and equipment from the operating

area, helps apply a dressing to the surgical site.

The ideal role of the circulating nurse in addition to the

roles that I mentioned above is:

❖Checks all equipment for proper functioning such as

cautery machine, suction machine
❖Assists the anesthesiologist in positioning the patient

❖Exposes the area for skin preparation

❖Ensures the theater door remain closed and the

patient’s dignity is upheld

❖Ensures that the theater is ready for the next case.

The ideal role of the anesthesia nurse in addition to the

roles that I mentioned above is:

❖Should be well aware of vital signs shown by the

patient

❖Be proficient in other medication procedures such as

dressing the patients

❖Ensures proper aseptic conditions during the surgical

operation time or at the time when anesthesia is provided
to the patient.

Skills that I learned from this setting:

Ensure that you are familiar with the scope of practice
specific for your level of study as this will enable both the
mentors and yourself to have a firm and common
understanding of your clinical knowledge, clinical skill
level and capabilities for the clinical placement. The scope
of practice outlines what duties you can and cannot
legally perform.

Getting feedback from mentors is vital for understanding

where you are at in your learning and development as a
nursing student.

Seeking feedback on clinical knowledge and skills has

enabled me to identify aspects of nursing that I am doing
well and areas that require improvement. Asking
questions and seeking clarification guided me in ways to
address these areas for improvement and increase my
areas of strengths.

Recombination for the sitting to be ideal:

Focusing on aseptic techniques and sterilization methods,
applying more attention patient's dignity and privacy.
More importantly, dividing tasks in an orderly manner
according to everyone's roles from members of the
operation theater team.