Never underestimate the importance of asking "why?"

AORN Journal, Dec, 2005 by Nancy J. Girard

One of the most important one-word sentences that exists is "Why?" It stimulates thought, leads the quest to find answers, and helps solve problems. Children innately ask why so frequently that it can drive their parents crazy, but adults often lose this curiosity.

In today's evidenced-based practice environment, this question is even more important. Nurses often blanch when they hear the word research or are asked to undertake a quality improvement project. Students get weak in the knees when they learn one of their assignments is to investigate a theory and develop a hypothesis about a topic. These activities, however, are all rooted in the "why" of something.

TEACHING STRATEGY

Socrates, an Athenian philosopher who lived from 469 to 399 BCE (le, before the common era), (1) used a questioning strategy when teaching a group of elite and arrogant young men. To teach them to think, he asked questions rather than providing answers. (1) This method of teaching is powerful, and it still is being used today to encourage thinking and creativity. (2) Today, there also are books and web sites (3) that answer the "why" of things, and more people are turning to the Internet to find answers. This can be good; however, not everything that is posted on the Internet is factual. Facts need to be questioned and evaluated. (4)

A "WHY" CLINICAL SITUATION

It has been said that one must ask "why" five times to get to the root of a situation or problem. This became true for me when I worked as a perioperative clinical nurse specialist. I was called to the postanesthesia care unit (PACU) to hear a complaint regarding the perioperative nurses. It seemed that they constantly sent patients to the PACU on a stretcher that was broken (ie, the head could not be raised). This restricted the PACU nurses from raising the head of the bed when managing a patient's airway or helping them to wake from anesthesia. The nurses in the PACU complained to the OR, but the problem was not resolved, and they wanted me to write a new policy on sending patients to recovery. Before proceeding further, I started to ask five "why" questions.

* I asked the OR nurse why she had put the patient on a broken stretcher. The nurse said it was because it was the stretcher outside the room. She was not aware it was broken and did not have time to look for another stretcher.

* I asked the OR director why a broken stretcher was being used. She said that it is what the transporters brought.

* I asked the transporters why they brought a broken stretcher. They said they had reported the problem to maintenance several times and even put a sign on it, but when the OR called, the broken stretcher was the only one available.

* I asked maintenance why they did not repair the broken stretcher. They replied that they had ordered a part and it had not yet come in. There were not enough stretchers, so the broken one was used.

* I asked purchasing why the part for the stretcher had not come in yet. They said that part was obsolete and could not be replaced.

I put in a proposal to order new stretchers. The proposal was approved and this solved the problem.

LESSON LEARNED

The lesson I learned was to ask the question "why" and not settle for an unresearched solution (eg, accusing the perioperative nurses and putting another policy or procedure in place). Perioperative nurses are smart, clever, and creative; however, they live in a prescriptive environment where every action is preplanned and every thought has a guideline. Sometimes, nurses become so accustomed to having clear directions for every step of every process that they forget to ask why they are doing it. The theory behind the action is forgotten in the automatic habits forged in the OR. When habits take over thinking, anything outside the norm can be confusing, and the correct action can get lost. The reason something is done can be missed in the translation from theory to action.

AORN helps perioperative nurses by preparing guidelines and recommended practices that are developed by asking why and using the most recent evidence for best practices. The cognitive ability of perioperative nurses to think and ask why, however, remains the most effective tool we have. The excellent research and quality improvement articles published in the AORN Journal demonstrate the inquisitive nature of practitioners. In translating these new ideas or any information into practice, perioperative nurses must ask why and evaluate their findings.

NANCY J. GIRARD

RN, PHD, FAAN

EDITOR

NOTES

(1.) "Socrates," Philosophy Pages, http://www.philosophypages.com/ph/socr.htm (accessed 24 Oct 2005).

(2.) "Socratic teaching," Fresno County Office of Education: California Pass Program, http://www.cyberhigh.fcoe.k12.ca.us/PASS_Program/methodology/ Socraticteaching.htm (accessed 24 Oct 2005).

(3.) "The why files top 5," The Why Files: University of Wisconsin Board of Regents, http://whyfiles.org (accessed 24 Oct 2005).

(4.) "Evaluating web pages: Techniques to apply & questions to ask," University of California Berkeley Library, http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/ Evaluate.html (accessed 24 Oct 2005).