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 JULY 2007
The Surgical Technologist
n today’s operating room, the surgical team, com-posed o both proessional and paraproessionalmembers, plays a vital role in the successul outcomeo any surgical intervention. Te teamwork model o integrated unction and interaction is the oundationalbasis that osters a blending o the strengths o the vari-ous team members as they come together and work as aunit in the operative setting.It is the synergy o this team—each with their ownproessional knowledge, skills and behaviors—that pro- vides the structure and environment that assure the deliv-ery o sae patient care and enable the patient’s return toan optimum level o wellness.Te egistered urse and the ertifed urgical ech-nologist unction as a subunit within this team, interact-ing through the utilization o a unique, dynamic relation-ship—that o our hands and two minds, one sterile roleand one nonsterile role, working in interdependent col-laboration, cooperation, and mutual support to managethe complexities o the highly technical, specialized oper-ating room environment and to deliver sae patient care.Using the context o the patient undergoing vaginalhysterectomy, this article will highlight the roles andinteractions o these two members o the surgical team—the circulator and the scrub.
Ann Marie McGuiness, cst, cnor, mse
Teri Junge, cst, cfa, fast
 A Teamwork Approachto Quality Patient Carein the Operating Room
Editor’s Note:
Duig a pevious AS atioal co- feece i New Oleas, Betty Schultz, rn, who wasthe pesidet of AORN, discussed patiet safety adhow collaboatio betwee pofessioals i the cicu-latig ad scub oles have the potetial to ehacethe goal of quality patiet cae.Tis led to the idea of a aticle co-authoed bya CNOR ad a CS that would demostate how thetwo sugical team membes pefom idepedetly,but iteact mutually to esue a safe patiet outcome.Te esultig aticle focuses o collaboatio. Much of the itoductoy ifomatio may appea asa eview fo may pactitioes, but it is icluded toaddess the distict pespectives of the two pofessios.Both authos believed that the case-study fo-mat would most effectively illustate the oles of theCNOR ad CS withi the cotext of patiet safety.Te efeece mateial was selected fom multiplesites that ae elevat to both pofessios.Tis aticle also seves to itoduce a ew patiet cae model called CARE, which melds the A-PIE model familia to uses ad the A POSitiveCae appoach familia to sugical techologistsad published i the AS-witte textbook,
SurgicalTechnology for the Surgical Technologist.
     ©     i     S    t    o    c     k    p     h    o    t    o .    c    o    m     /     C     h    r     i    s    t     i    n    e     B    a     l     d    e    r    a    s
The Surgical Technologist
 JULY 2007
283 JULY 2007 3 CE CREDITS
Te circulator role is primarily flled by the eg-istered urse (). ertiication by the om-petency and redentialing Institute (I) as aertifed urse perating oom () is thepreerred credential or those individuals prac-ticing in the capacity o circulator.he ocus o the circulating role is one o patient assessment, saety and advocacy, as wellas the technical skills o operating room manage-ment. In many acilities, the circulator is assistedby the ertifed urgical echnologist in deliver-ing sae patient care outside the sterile feld andin perorming the technical skills o the operat-ing room that all within their scope o practice.Te scrub role is primarily flled by the er-tiied urgical echnologist (). ationalcertiication by the ational Board o urgicalechnology and urgical ssisting (B) asa ertifed urgical echnologist is the preerredcredential or individuals practicing in this role.Te ocus o the scrub role is one o managemento the sterile feld.Te roles o both the circulator and the scrubare complex and involve an interdisciplinary approach toward:
are o the patient and surgical team members
pplication o the principles o asepsis andimplementation o the practice o steriletechnique
wareness o the environment
Knowledge o normal regional anatomy andphysiology 
n understanding o the pathophysiology related to the planned surgical intervention
Knowledge o the operative procedure andits variations
Identifcation and management o variationsthat may be specifc to the patient (eg, size orcomorbid conditions) or surgeon
he day-to-day delivery o quality patient care isone o the most important responsibilities andduties o the surgical team members. It is importantthat this patient care be delivered based on a collab-orative utilization o critical thinking models.ne model—the -I model, derived romthe work o Ida Jean rlando—is a nursing-pro-cess model based on the concepts o ssessment,lanning, Intervention, and valuation. second model, utilized by the surgical tech-nologist—the  itive  model, derivedrom the work o Bob aruthers, CS, P
D, ocus-es on the technical aspects o patient care. heacronym  itive  represents knowl-edge o natomy, athology, the perative pro-cedure and its peciic variations, while keep-ing in mind the are directed toward the patientand/or team, septic principles and sterile tech-nique, the ole o the team members, and nvi-ronmental awareness and concern. third model, the  model, was developedby the authors o this article. he  modelembraces the essence o both the -I and  -itive  models and provides a common path-way or interaction among surgical team members.
he  model is an integrated model o patient care practice that includes active partici-pation and collaboration by all members o thesurgical team. It integrates and shows the prima-ry relationship between the roles o tech and cir-culator in the provision o patient-ocused carethroughout the intraoperative period.
The CARE model involves collaborationby all members o the surgical team indelivering patient-ocused care.
 JULY 2007
The Surgical Technologist
It includes the concepts o ommunication,ssessment, ecommended standards and guide-lines, and the xecution o policies and proce-dures. Tis model is simple to remember, demon-strates an interdependent relationship among the various practitioners as they perorm their dutiesand execute their responsibilities, and can easily be utilized by any member o the surgical team toprepare or and carry out the various componentsinvolved in the delivery o quality patient care.
uring a surgical intervention, the circulatorand scrub must work together as a unit, in a man-ner that emulates the true meaning o the word“team.” Tis intraoperative team carries out themyriad tasks and activities that assure the mostpositive patient outcome possible.Interaction occurs beore, during, and aterpatient contact to assure that the instrumenta-tion, supplies, equipment and specialty items aregathered, prepared and delivered to the surgeonand assistant in a timely and ecient manner—minimizing the patient’s exposure to anesthesiaand surgical trauma. ective teamwork requiresplanning and utilization o strategies that allowsmooth, uninterrupted perormance o eachindividual’s tasks and responsibilities.ne key to the success o any team is the useo positive communication. In light o the act thatthis intimate subunit must rely upon each other orollow-through o many aspects o a related task,positive communication becomes the linchpin thatbinds the team into a single unctioning unit. close-knit intraoperative team communi-cates on many levels, both verbally and, moreoten, nonverbally. he circulator assesses thepatients unique needs and develops an individu-alized plan o care. Tis care plan is shared withthe scrub, including patient allergies, patient lim-itations and any additional inormation, such aspatient size, that may aect procedural activities.Te circulator perorms ongoing patient andsterile feld monitoring, anticipating and deliver-ing needed items in a manner that permits theprocedure to ow smoothly and without inter-ruption. Te scrub monitors the sterile feld, thesurgical team and the unolding events o thesurgical intervention—sharing observations andspecial requests with the circulator in a timely manner, which enables them to work together inmeeting the surgeon’s and patient’s needs.ommunication not only occurs between thescrub and circulator, it also involves sharing inor-mation among other team members, the patientand any other caregivers who are able to pro- vide additional inormation and input needed todevelop a clear picture o the many patient vari-ables that may inuence their intraoperative care.dmitting personnel and sta gather knowl-edge and assess the patient, documenting inor-mation that plays a vital role in addressing theunique needs o each and every patient.Te surgeon is an integral part o this commu-nication team. He or she best knows the patient’schie complaint and has had the opportunity todiscuss individual patient concerns relevant totheir biopsychosocial needs. By communicatingthis inormation to the intraoperative team, thesurgeon can be assured that both the routine andspecialty items required or the procedure areprepared in a timely and proessional manner.
 As the circulator ananesthesia provider assess the patient’sindividual needs,it is important that any inormationthat afects surgical intervention be shared among almembers.

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