title: Unsettled teamwork: communication and learning in the operating theatres of an urban hospital.
abstract: OBJECTIVE
  To explore the unsettling effects of increased mobility of nurses, surgeons and other healthcare professionals on communication and learning in the operating theatre.
  
  
  BACKGROUND
  Increasingly, healthcare professionals step in and out of newly formed transient teams and work with colleagues they have not met before, unsettling previously relatively stable team work based on shared, local knowledge accumulated over significant periods of close collaboration.
  
  
  METHODS
  An ethnographic case study was conducted of the operating theatre department of a major teaching hospital in London.
  
  
  METHODS
  Video recordings were made of 20 operations, involving different teams. The recordings were systematically reviewed and coded. Instances where difficulties arose in the communication between scrub nurse and surgeons were identified and subjected to detailed, interactional analysis.
  
  
  RESULTS
  Instrument requests frequently prompted clarification from the scrub nurse (e.g. 'Sorry, what did you want?'). Such requests were either followed by a relatively elaborate clarification, designed to maximize learning opportunities, or a by a relatively minimal clarification, designed to achieve the immediate task at hand.
  
  
  CONCLUSIONS
  Significant variation exists in the degree of support given to scrub nurses requesting clarification. Some surgeons experience such requests as disruptions, while others treat them as opportunities to build shared knowledge.
authors.affiliation: UCL Institute of Education, UK.
authors.forename: Jeff
authors.initials: J
authors.lastname: Bezemer
authors.affiliation: UCL Institute of Education, UK.
authors.forename: Terhi
authors.initials: T
authors.lastname: Korkiakangas
authors.affiliation: Imperial College London, Clinical Skills Centre, UK.
authors.forename: Sharon-Marie
authors.initials: SM
authors.lastname: Weldon
authors.affiliation: UCL Institute of Education, UK.
authors.forename: Gunther
authors.initials: G
authors.lastname: Kress
authors.affiliation: Imperial College London, Clinical Skills Centre, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Kneebone
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D003299:Cooperative Behavior; D005260:Female; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007400:Interprofessional Relations; D008131:London; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D009873:Operating Rooms / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration; D066231:Surgeons / Q000523:psychology*; D013663:Teaching / Q000379:methods*
keywords: communication; learning; migrant nurses; mobility; nurses; operating theatre; surgeons; teamwork