The influence of context on role behaviors of perioperative nurses

AORN Journal,  Dec, 2004  by Helen E. McGarvey,  Mary G.A. Chambers,  Jennifer R.P. Boore

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Perioperative nursing has evolved over approximately 120 years, largely as a result of developments in surgical technique, technological advances, and changes in the role of women in society. Although the profession developed out of the need for surgical assistance, new role developments are beginning to affect how care is provided to surgical patients. As with perioperative nurses globally, nurses in the United Kingdom work in settings that abound with technological advances, pioneering surgical techniques, and increasing workplace pressures. Furthermore, recruiting nurses to work in this speciality is challenging. As a result, providing high-quality patient care is an increasingly complex task.

Northern Ireland is separate from, but has strong governmental links with, mainland United Kingdom. The National Health Service that exists throughout the United Kingdom was established in the 1940s, and it operates on the fundamental principle of free and equal access to health care for all individuals. The service has become increasingly strained over the years, however, as waiting lists for surgical procedures have grown and the nursing shortage has worsened. Changes in government policy and professionally driven agendas have affected nursing in general, and within operating departments, nurses have experienced considerable change.

STUDY AIM AND OBJECTIVES

The aim of this study was to conduct a focused investigation on the role of nurses in the operating department.

Specifically, the objectives were to

* examine the role performance of a sample of perioperative nurses in Northern Ireland and

* investigate the effect of the operating department context on the performance of the nursing role.

LITERATURE REVIEW

A literature review found that although various perioperative research studies had been carried out in the 30 years preceding this study, few were relevant to the goals of this study. In addition, the majority of research originated in the United States and, thus, could be applied only tentatively to the Northern Ireland setting.

The development of the nursing role in the operating department and an analysis of research about the perioperative role are reported elsewhere. (1) Although the term perioperative nursing encompasses the nursing role from the time the decision is made for surgery until the resolution of surgical sequelae, (2) for the purposes of this study, the term is restricted to describing the nursing role within the four walls of the operating department (ie, the immediate preoperative, intraoperative, and immediate postoperative periods).

THEORETICAL FRAMEWORK

The theoretical basis for this study comes from role theory. This is appropriate because nursing literature repeatedly uses the term role, and it is a term with which nurses already are familiar. Furthermore, the focus of this study is on people and their behaviors in a specific occupational context. One researcher suggests that role theory is "a science concerned with the study of behaviors that are characteristic of persons within contexts." (3 (p4)) Another researcher views rode theory as

   a collection of concepts and a variety
   of hypothetical formulations that
   predict how actors will perform in a
   given role or under what circumstances
   certain types of behaviors can
   be expected. (4 (p17))

The underlying assertion of role theory relevant to this research is that

* a person's values, attitudes, and beliefs are linked to the roles he or she plays within the social environment; (5)

* role performance is influenced by context and the individuals who perform in that context; (6) and

* role theory supports the link between the expectation of role performance and the behavior itself. (3)

No recent works relating to the use of role within perioperative nursing emerged during the literature search. Given its relevance to the topic under study, however, it was chosen as the most appropriate theoretical background for this study. Role is an exceptionally diverse term, and the literature is divided about how it should be defined. For the purposes of this study, role was defined as "behaviors characteristic of one or more persons in a context." (3 (p58))

PRELIMINARY STUDY

The absence of any previous significant research on this topic in the United Kingdom meant that a preliminary study had to be carried out to determine whether the topic was worth further investigation before resources could be used. The preliminary study provided a theoretical framework that was used to guide the main study. The details of the preliminary study are presented elsewhere. (7)

DESIGN AND METHODS

The basic criterion for studying role behavior is to identify the relevant social system or subsystem and then locate recurring events that fit together. (8) This can be done by ascertaining the role expectations of a given set of related offices because such expectations are the main elements in maintaining the role system and inducing the required role behavior. In the past, role theorists have adopted methods of research that involved observing roles and that required research participants to report their own or others' expectations in relation to their role. (8,9) This allowed in-depth examination of role and role performance. A case study design was selected because it best facilitated the investigation of role behavior within its natural context. In addition, to embrace the flexibility required in this study, a qualitative approach was chosen.