COUNTING AS CARING

Canadian Operating Room Nursing Journal,  Sep 2007  by Downey, Chris

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Despite this redistribution of power among doctors and insurance companies, the OR, as far as the courts were concerned, remained a surgeon's domain. Surgeons were responsible for everything that went on and lawsuits during this period of time were low,

"...the operating surgeon must take legal notice of the fact that in the O.R., he is the master and has control over, and is responsible for, the acts of orderlies, nurses and his associates."8

During this time nursing schools began to separate students from the regular hospital workforce. Training was becoming more theoretical and students were being taught the rationales for nursing practice.9 Better education for nurses came after 1945 as a result of the fact that perioperative nurses had shown, during World War II, that they could be educated to do some jobs previously assigned only to surgeons. These jobs were most commonly the role of surgeon's scrub nurse and first assistant. These nurses learned to assess, or triage, surgical patients, to suture, to ensure hemostasis, and, many times, to open and close the incision itself,

"In this role, nurses opened and closed wounds; the surgeon performed the internal interventions. Tying and clamping of bleeders was a routine nursing function. Nursing experience with abdominal and chest surgery was increasing, and nurses sometimes performed procedures such as tracheostomy and chest tube insertion."10

This specialized education of perioperative nurses, outside the schools of nursing, also increased their personal awareness of their role as patient advocate and of their responsibilities to patients, staff, and students. It allowed them, through their professional organizations, to question the status quo and to become more self-directed:

"The first national conference of AORN [Association of Operating Room Nurses] was held in February 1954, with the major topic 'Where Do We Belong?'. Through this peer support, operating room nurses began to identify themselves as leaders, supervisors and teachers."11

This was seen to be a shift in power for nurses as their authority regarding perioperative nursing was being clearly identified, their education and abilities to perform what had been traditional surgeon's work increased, and nurses began to feel able to pass judgement on a surgeon's abilities.

Advancements in technology, during the late '50s and early '60s, would greatly impact on the practice of surgery. Technologies such as the cardiopulmonary bypass machine (allowing surgeons to perform open heart surgery), blood transfusion equipment (allowing for emergency surgery of unstable patients), and ventilators for anaesthetized patient (allowing for an increase in the duration of surgical procedures), dramatically changed surgery. The formulation of antibiotics also reduced risk of postoperative infection and sepsis.12

These advancements influenced the practice of counting. First, increased numbers of instruments were now required for more specialized interventions such as cardiac, thoracic and vascular surgery, and second, the size of the instruments varied from large to very small. Nurses knew what basic instruments were required, what specialized instruments were required, how to clean, sterilize, and maintain them for optimal use. Perioperative nurses not only cared for their patients- they also "cared" for the instruments. The more instruments and the smaller the instruments the higher the risk of leaving them in the patient.