Conscience is a man’s compass to come up with right decisions.

According to Merriam
Webster’s dictionary, conscience is defined as a sense or consciousness of the moral
goodness or blameworthiness of one's own conduct, intentions, or character together
with a feeling of obligation to do right or be good. In wondering about the right thing to
do, a person has three options. There is the consultation of religion, consultation of
others and consultation of one’s self. As religion is what others say that God has said,
the first two amount to the same thing. As everyone must consult himself in giving
consultation to others, the second two amount to the same thing. In consulting with
one’s self, there is the conscience (White J.B, 2006).

Regardless of spiritual beliefs, as human beings, each of us has conscience. It’s that “little voice”
inside that helps each of us distinguish between right and wrong. In recent years, the idea of a
human conscience has been extended to the operating room, where “surgical conscience” has
become a rallying cry for many health care professionals and patient safety advocates. The
term refers to the concept of human conscience as it applies to the performance of all of the
activities that occur in the operating room. Specifically, refers to the policies, standards and
best practices recommendations that dictate proper procedures for every activity from
scrubbing, gowning, gloving techniques to patient positioning, aseptic techniques and
maintenance of infection control measures (Sadler, 2012).

The concept of a surgical conscience may simply be stated as a surgical Golden Rule:
do unto the patients as you would have others do unto you. The caregiver should
consider each patient as himself or herself or as a loved one. Once an individual
develops a surgical conscience, it remains inherent thereafter (Fortunato, 2012).
Surgical conscience is an in-built discipline of consistent awareness and practice of
surgical rules in an individual, even in the absence of external monitoring of such
individual (Hopper, et al, 2010). It is the foundation upon which the skills and techniques
employed by the surgical personnel are built. The “knowledge” and “application” of the
principles of sterile technique by all theatre staff and others caring for surgical patients
is the hallmark of the doctrine of surgical conscience, and indifference to this doctrine is
a precursor to surgical infractions (Denver, 2014).

Reports from Institute of Medicine (IOM) drew attention to patient safety issues and with
more stringent economic measures in healthcare, greater efforts are required to reduce
the burden of surgical patients through practice of surgical conscience. The advent of
surgery, no doubt, has brought succor to man’s quest for improved health status. Many
illnesses that previously proved incurable or recurrent have been tackled by the timely
emergence of surgical practice. Acting on personal surgical conscience involves
knowledge, self-awareness, intelligence, and the courage to make ethical and moral
decisions that benefits the patients (Girard, 2015). In her view, surgical conscience is
evidenced by consistently exhibiting ethical behaviour, promoting patient safety, and
doing the right thing even when no external monitors are present. Surgical conscience
was described as an awareness that develops from a knowledge base of the
importance of strict adherence to principles of aseptic techniques. She concluded that
optimal patient care requires an inherent surgical conscience, self-discipline, and the
application of principles of sterile and aseptic techniques, which are all inseparable
related.

Study shows that despite the expertise of operating suites workers and those caring for
surgical patients, complications such as surgical site infection, prolonged wound
healing, breakdown and blood borne infections still occur, which results in patients
spending more money and time in the hospitals. The question to ask is ‘what account
for these complications despite the level of training in such hospitals?’ Is it due to
absence of surgical conscience? The influence of surgical conscience on nurses has
frequently been described but its impact on care has received less attention. The study
was therefore designed to assess nurses’ surgical conscience and the perceived
barriers in practicing surgical conscience in preventing surgical site infection.

Introduction

An inherent part of health care is respect for human rights and treating individuals with consideration and
dignity. The common values that should govern professional practice are described in codes of ethics and
guidelines: to promote health, prevent disease, restore health and alleviate suffering. Studies have shown
that nurses’ professional practice rests firmly on these codes (International Council of Nurses,
2005). Values such as altruism and concern for patients’ health and well-being appear to be paramount,
as is the moral standpoint on which nurses base their work ( Fagermoen, 1997). Nurses wish to provide high
quality care and a desire to help patients is common to registered and enrolled nurses, as well as
physicians.5 Nurses place high demands on themselves in their ambition to provide patients with high
quality care, which they believe correspond to those that
patients place on them also.6
The literature contains many views on the nature of conscience. In theology it can be considered from the
perspective of faith or outlook on life, in which case it has a clear moral connection, 7 while from a
philosophical or psychological point of view it is a theoretical construct dependent on individuals’ thoughts
and feelings.