title: Nurse-surgeon object transfer: video analysis of communication and situation awareness in the operating theatre.
abstract: BACKGROUND
  One of the most central collaborative tasks during surgical operations is the passing of objects, including instruments. Little is known about how nurses and surgeons achieve this. The aim of the present study was to explore what factors affect this routine-like task, resulting in fast or slow transfer of objects.
  
  
  METHODS
  A qualitative video study, informed by an observational ethnographic approach, was conducted in a major teaching hospital in the UK. A total of 20 general surgical operations were observed. In total, approximately 68 h of video data have been reviewed. A subsample of 225 min has been analysed in detail using interactional video-analysis developed within the social sciences.
  
  
  RESULTS
  Two factors affecting object transfer were observed: (1) relative instrument trolley position and (2) alignment. The scrub nurse's instrument trolley position (close to vs. further back from the surgeon) and alignment (gaze direction) impacts on the communication with the surgeon, and consequently, on the speed of object transfer. When the scrub nurse was standing close to the surgeon, and "converged" to follow the surgeon's movements, the transfer occurred more seamlessly and faster (<1.0 s) than when the scrub nurse was standing further back from the surgeon and did not follow the surgeon's movements (>1.0 s).
  
  
  CONCLUSIONS
  The smoothness of object transfer can be improved by adjusting the scrub nurse's instrument trolley position, enabling a better monitoring of surgeon's bodily conduct and affording early orientation (awareness) to an upcoming request (changing situation). Object transfer is facilitated by the surgeon's embodied practices, which can elicit the nurse's attention to the request and, as a response, maximise a faster object transfer. A simple intervention to highlight the significance of these factors could improve communication in the operating theatre.
authors: Department of Surgery and Cancer, Imperial College London, UK; Department of Culture, Communication and Media, Institute of Education, UK. Electronic address: t.korkiakangas@ioe.ac.uk.
authors: Terhi
authors: T
authors: Korkiakangas
authors: Department of Surgery and Cancer, Imperial College London, UK.
authors: Sharon-Marie
authors: SM
authors: Weldon
authors: Department of Culture, Communication and Media, Institute of Education, UK.
authors: Jeff
authors: J
authors: Bezemer
authors: Department of Surgery and Cancer, Imperial College London, UK.
authors: Roger
authors: R
authors: Kneebone
mesh_terms: D003142:Communication; D013502:General Surgery; D009873:Operating Rooms; D013527:Perioperative Nursing; D013525:Surgical Instruments; D014741:Video Recording
keywords: Body movement; Communication; Instrument trolley; Scrub nurse; Situation awareness; Surgeon