Surgical conscience model addresses moral concerns in medical settings
To come up with this model, clinical assistant professor and certified perioperative nurse Danielle Quintana drew upon recent and historical scientific literature and her experience as a operating room nurse for nearly 20 years.
According to Quintana, nurses use surgical conscience to keep patients safe in the operating room. It consists of three parts – knowing what is sterile and safe and what isn’t, accepting a moral obligation to advocate on behalf of the unconscious patient and acting courageously to keep the patient safe.
“The nurse’s surgical conscience tells the nurse that no matter how difficult, they must speak up and do the right thing on behalf of the patient,” Quintana said.
She hopes when nurses face difficult decisions in the OR, they can now call upon her model to help inspire them to do the right thing. For example, suppose a surgeon contaminates their gloves during surgery. In that case, the nurse has an obligation to speak up about what they noticed, even if the surgical team’s reaction may not be positive.
“As a perioperative nurse for nearly 20 years, a strong surgical conscience has always been my golden rule for my practice,” Quintana said. “It is something I used on each and every surgical procedure I have ever been part of – which is probably over 75,000 cases at this point in my career.”
Quintana was concerned that the concept of surgical conscience has had little in the way of formal research despite the idea being around since the early 1900s.
“Something so influential in perioperative nursing practice cannot be improved if we do not understand how it is best learned and how it can best be strengthened,” she said. “It is also important to know what may weaken one’s surgical conscience so we can help mitigate those factors.”
Her research involved a concept analysis, which helped her define surgical conscience more precisely and operationally. This more precise definition led to a better understanding of the best way to measure the collection of moral factors that comprise Quintana’s research.
Quintana’s next step in her research is to develop an instrument to measure surgical conscience in perioperative nursing. She expects to complete it in spring 2023 for her dissertation and then use it to understand what interventions can be used to improve surgical conscience.
“This model helps remind us that when a difficult situation is taking place in the OR, it is not about us, but about the patient,” Quintana said. “If every perioperative team member is using their surgical conscience in a culture of safety, think about the exponential positive effect this would have on behalf of the patient.”