Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
of open, clear and precise communication, the residual culture of
subordination and domination creates restricted communication
patterns.
The Operating Room Culture
As a participant in the operating room culture for the past 18
years, I know that it is a complex environment. It is also evident
that there is great variation in the communication between team
members.
In the operating room, team members are trained to be
attentive to the surgeon and anesthesiologist in an effort to care for
the patients within the OR proper. This training comes with at least
these four assumptions. First, the surgeon is the leader in the OR,
or better known as the captain of the ship. Second, everyone else’s
speaking is secondary to that of the surgeons. Third, nurses,
technologists and non-clinical personnel are to speak only when
spoken to, unless there is an urgency and or emergent situation
with a patient or the environment. Fourth, open fluid
communication is not the norm and or even understood by the team
members.
One consequence of the culturally-appropriate dominance of
the surgeon in the OR is that conversational contributions by any
other team member may be ignored; the surgeon maybe the only
person who is heard. Although this pattern of dominance and
subordination is culturally sanctioned, it generates negative feelings
and invidiously affects the OR team’s ability to communicate with
the openness that they sometimes need.
Healthcare Communication, Current Research and Relevance
In one way of thinking about the OR as a social setting, it
“consists of a complex mixture of materials, stories, and skills in
which not all voices are granted equal hearing, not all skills are
equally appreciated and not all practices are facilitated” (Pearce,
1989, p. 197). Due to the hierarchies and varying professionals that
exist within the context of healthcare there is variability in
communication and meaning (Miller, 2005), which then increases
inconsistency in our care delivery process. This variability stems
from the development of our language in that each professional
group has its own roots which contribute to the use of professional
meanings (Wittgenstein, 1981). Due to the communication
variability of meanings among healthcare professionals and the
complexity of the many hierarchal relationships (Thomas, et al.,
2004) and overlapping processes within the context of healthcare
delivery it is difficult to discern where to begin in trying to develop
improved communication.
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