The Operating Theatre Journal - Flipbook - Page 20
A students re昀氀ection on an experience within the Obstetrics theatre
Emma Fraser S21 BSc Operating Department Practice Student
Within this essay I will be re昀氀ecting on an experience during my
surgical placement, while scrubbed for an elective lower segment
caesarean section. The Health and Care Professions Council (HCPC,
2021) require registrants to regularly re昀氀ect upon their practice, to
enhance their continued professional development. Re昀氀ection allows
one to positively and negatively analyse situations and to highlight ways
in which changes to practice can be made for continued care and safety
of service delivery and practitioner progression. Clinical re昀氀ection can
be effective in analysing more complex situations and to be able to
process and manage the outcomes constructively. Therefore, for this
re昀氀ection I will be using Gibbs’s (1988) model of re昀氀ection. Gibbs’s
(1988) model requires a deeper analysis of an experience by initiating
deeper evaluations to occur. Gibbs’s (1988) six step model initiates
further questioning of experience compared to Driscoll’s (2001)
model, which I used previously for re昀氀ecting. Thomas, et al (2014)
describes interprofessional working as a mixture of practitioners and
bodies that work together to provide mutually agreed, individualised
care of a patient. I will analyse the interprofessional working within
this experience and how this affected the team’s ef昀椀ciency. How
the collaboration affected my learning and patient care, whilst,
highlighting the obligations and requirements set out by my regulatory
body, HCPC (2014). Furthermore, this essay will highlight the impact
of human factors, the barriers too and bene昀椀ts of re昀氀ecting on my
own and others practice. I will analyse my experience and will propose
solutions for improvement within my practice, learning and role
within collaborative practice. All information within this essay has
been anonymised to protect and uphold con昀椀dentiality and anonymity
standards. No data used within will enable identi昀椀cation of place,
patient or staff. Registrants are required to maintain con昀椀dentiality
for the protection of the service user and organisation (HCPC, 2021).
I was solo scrubbed for an elective lower segment caesarean section.
The team and I had all participated in Vickers (2011) 5 steps to
safer surgery’s 昀椀rst step, team brief, prior to the patient’s arrival
to theatres. Induction, and delivery of baby was successful, and the
patient was being sutured. Upon vaginal examination it was discovered
the patient was having a post-partum haemorrhage. As a student I
had not participated or observed this complication before. As I was
scrubbed it was my responsibility to assist in the setup of the Bakri
balloon, however, I had not yet seen this in practice and found this
quite dif昀椀cult. Furthermore, this dif昀椀culty was increased by the
number of practitioners talking to me in assistance. Additionally, wrong
resources were collected during this time, due to new staff members
being part of the team. The performing surgeon was clearly distributing
commands on what was needed and necessary for this intervention. A
practitioner put on sterile gloves and assembled the Bakri balloon and
the necessary resources. The practitioner assisted until the patient’s
haemorrhage was stabilised. The patient was taken to recovery and the
team was debriefed as part of Vickers (2011) 5 steps to safer surgery.
The practitioner debriefed me further and we opened and assembled
a Bakri balloon and explored the emergency obstetrics trolley. The
performing surgeon discussed with me they felt that I had remained
calm throughout the situation, and this was a positive aspect within
my practice.
Throughout the caesarean section I felt quite con昀椀dent. I had scrubbed
solo multiple times for caesareans and felt con昀椀dent within my practice.
However, when the case turned emergent due to the haemorrhage I
felt out of my depth. I instantly lost all con昀椀dence within myself and
the practice I had begun to form. I became stressed and worried that
I would be unable to ef昀椀ciently complete tasks and I was stressed as I
felt that I was harbouring the care delivery to maintain this patient’s
safety. Furthermore, I became too worried to speak up and was unable
to state that I was could not determine a clear set of instructions and
needed help.
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The positives of this experience were the learning opportunities
of scrubbing for a caesarean section, with the experience of an
obstetric emergency. I was fully included within the team brief and
was debriefed after the case. Additionally, this experience led to
a further exploration and teaching of obstetric emergencies and
equipment which further built my understanding and knowledge.
Alternatively, the communication between the team broke down and
was inef昀椀cient, which was a negative. This led to a delay in care. The
poor communication increased the risk of harm, as the communication
delivery led to confusion and panic within the theatre, which negatively
impacted the team’s ef昀椀ciency. Additionally, I was unable to identify
the need for further assistance within the scrub role when the case
turned emergent. I was unable to speak up and ask for help, which
adversely affected the care delivery and ef昀椀ciency. Furthermore, there
was a lack of clear leadership amongst the circulating team which
impacted negatively. In addition, I was not placed with my practice
educator and was placed with a practitioner I had not worked with
previously.
Prior to the case commencing, the team briefed in accordance with
Vickers (2011) 昀椀ve steps to safer surgery. Vickers (2011) 昀椀ve steps
has been attributed to better communication and patient safety. All
team members actively participated, and identi昀椀cation of name and
role occurred. Additionally, it was highlighted that I was a student,
but my competency in emergency obstetrics was not. Had this of
been discussed we could have better prepared for complications, thus
preventing the confusion and delay. This information could have aided
the understanding and awareness of team members, as there would
have been more understanding of my lack of knowledge so tasks and
requests could have been delegated more appropriately. Cadman and
Lowes (2022) state unanticipated events within the obstetrics theatre
should be regularly prepared for, with statistics published by the
National Health Service (NHS, 2022) showing that twenty 昀椀ve percent
of all caesarean births in the 2021-2022 period suffered a post-partum
haemorrhage. Therefore, team members within should have knowledge
and understanding of obstetric emergency protocols and these should
be practiced regularly to decrease the risk to mother and baby. The
case began positively with good communication amongst the team,
communicating the patient had an ASA grade (American Society of
Anaesthesiologists, 2020) of two and no prior complication history,
however, there was insuf昀椀cient knowledge and effective teamwork
when complication arose.
Weaver (2021) suggests student learning experiences are enhanced
with opportunities to learn by doing, with practitioners facilitating
and encouraging learning by supporting students, rather than directing
or showing. Although, I was given the opportunity to solo scrub I am
lacking in key experience and skills to be able to assist in the event
of emergence. Moreover, I was not working with my practice educator
and was placed with a different practitioner, therefore there was
lack of knowledge of my current skill level. My own lack of awareness
prevented me from thinking of the possible instance of complication
as I was focused on the opportunity to scrub. My lack of awareness
prevented me from understanding the possible implication to patient
safety, highlighting the need to enhance my non-technical skills. The
Scrub Practitioners list of Intraoperative Non-Technical skills (SPLINTS)
handbook (University of Aberdeen, 2010) regards situational awareness
as one’s own ability to be aware of personal practice, surroundings
and changes to care. Similarly, the HCPC (2014) requires registrants to
be aware of their own skill and practice, requiring practitioners to be
accountable for conducting a safe practice. With the demonstration
and practice of good non-technical skills teamwork and patient safety
can be enhanced (University of Aberdeen, 2010).
Additionally, I had a limited communicative ability. Further poor
communication between the circulating team increased the ineffective
communication within the theatre. Furthermore, there was no clear
communication model being used. A feedback loop, such as Hargestam,
et al (2013) closed loop communication (CLC). CLC would have increased
the ef昀椀cacy of the communication and would have enhanced my ability
to be able to concentrate on a clear set of instructions. Hargestam, et
al, (2013) suggest teams using CLC had a higher success and performance
rate than teams who didn’t use CLC. Due to the multiple practitioner
involvement, it meant that the communication was ineffective. This
lack of communicative ability within the team could be due to the
lack of leader. Flin, et al (2008) suggests that hierarchy within teams
dictates the outcome.
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