Superstitions among perioperative nurses

AORN Journal,  May, 2005  by David L. Mandell,  Margie L. Claypool,  David J. Kay

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In today's science- and technology-driven health care environment in which evidence-based data are increasingly used to guide medical decision making, certain irrational beliefs that exist despite the absence of objective evidence (ie, superstitions) still are anecdotally prevalent among health care workers. (1) Among emergency department (ED) personnel, there is widespread belief that the presence of a full moon is associated with chaos, increased noise, heightened activity levels, and an above-average number of disruptive or disturbed patients (eg, those with traumatic or psychiatric complaints). (2,3) Some ED personnel believe that increased trauma cases and overall chaos also are associated with Friday nights and Friday the 13th in particular. (1) Some ED physicians avoid mentioning the word "quiet" when there is low patient volume, for fear of triggering a subsequent rash of activity. (1)

A recent survey of medical residents discovered that work-related superstitions are widespread, particularly with respect to on-call duties. (4) Residents commonly perceive that there are some among them who consistently have more difficult times on call, and they are considered to have a "black cloud" hanging over their heads. (1,4,5)

With respect to nurses and superstitions, not much has been published in the literature, but it is reasonable to suspect that nurses, like other practitioners of high-stress, unpredictable work, may be vulnerable to these types of beliefs. One of the few studies to address this issue found that in a survey of 25 ED nurses, 80% believed that the phase of the moon affected patients and their mental health. (6) The purpose of this study is to determine the prevalence of work-related superstitions among perioperative nurses.

SIGNIFICANCE

This investigation is significant in several ways. First, the data can help demonstrate whether superstitions are widespread among perioperative nurses, and comparisons can be made with the prevalence of superstitions found in other high-stress occupations. Second, identifying specific superstitions may allow for scholarly debate and study about them, opening new avenues for research to determine if some of the more widely held superstitious beliefs can be corroborated scientifically. Finally, by investigating the prevalence and nature of nursing superstitions, conjectures can be made regarding their etiology and the role these beliefs may play in allowing nurses to cope with the daily challenges of life in the OR.

LITERATURE REVIEW

Several studies have investigated medical personnel's superstitious beliefs. These include superstitions about the full moon, black clouds, and several other phenomena.

THE FULL MOON. One of the most commonly-held medical superstitions is that a full moon is associated with an increase in workload, stress level, number of trauma cases, and general work-related chaos. Three studies that examine this issue found that the full moon has no effect on trauma and ED admissions, despite popular belief to the contrary. In a study conducted at a hospital in Arlington, Mass, all ED admissions were reviewed during 12 consecutive lunar months. (2) When comparing the four-day period of the full moon to the other 25.5 days of the lunar month, there was no statistically significant difference in the average number of ED patients

* seen overall,

* seen with traumatic or psychiatric problems, or

* seen at night. (2)

All trauma admissions (N = 1,444) for one calendar year were reviewed during a study conducted at a level I trauma center in Pittsburgh. (7) The three-day period encompassing each full moon was compared to the remaining days of the lunar month. During full-moon periods, there was no increase in the

* total number of trauma admissions,

* total number of trauma patients hospitalized,

* mortality rate,

* mean injury severity score, or

* length of stay.

There also was no lunar variation noted in admissions of victims of violent crime. There were, however, fewer helicopter transfers of trauma patients on full-moon days.

In a study conducted at a Chicago hospital, all patients registered in the ED during a four-year period were studied (N = 150,999 patient visits).(3) Emergency department visits were grouped according to the day of the lunar month. There was no significant change in the mean number of total patients seen, nor was there any significant difference in the mean number and percentage of ED patients who

* arrived by ambulance,

* were admitted to the hospital, or

* were admitted to a monitored unit on full-moon days compared to any other day of the lunar month.

"BLACK CLOUDS." Researchers at a children's hospital in Chicago attempted to study the black cloud phenomenon among medical residents. (5) Nineteen first-year pediatric residents were followed during the course of a year and were interviewed the morning after each nightly on-call experience. The study found that some residents did indeed have a black cloud. These residents slept less on call, believed they worked harder on-call than other residents, and had developed a reputation among their fellow residents for having difficult on-call experiences. The study also found, however, that actual work load, defined as the number of admissions, patients on service, deaths, deliveries, and pediatric intensive care unit transfers, were the same for all residents. The researchers suggested that those residents who were perceived to have a black cloud had the same workload on call, but slept less, indicating that the primary problem was resident inefficiency.