Soooo, you're observing in the Operating Room (O.R.)... - page 6

A couple of tips and such to help: Dress Code: Give some serious thought into what attire you will wear into that dept. if you're allowed to wear something other than your clinical outfit on... Read More

  1. by   collegedean
    I fainted, one incident made me eat a good breakfast before i assist an O.R. case. it was so embarassing they called me "vaginal speculum" for the whole semester. now, everyday as i go to my duty or lectures i eat alot. and a bagel on my way to school. lol.
  2. by   mcknis
    I cant wait until this quarter so I can go observe my first procedure. I wont forget these wonderful tips either.
  3. by   Kat_86
    Things seem quite different over in America-I'm a student nurse in the UK
    Dress code:
    -we wouldn't be allowed to wear anything other than scrubs in theatre (OR), and it gets quite warm in theatre, espeially in summer
    -name tags don't seem to be worn in theatre (my only proper experience so far is in eye theatre, where it was always staff that knew one another as it was always staff from the eye dept there)
    -shoe covers aren't used-we have to wear theatre clogs
    -hats are a must and there are different coloured ones for different people, its how they are identified cos everyone wears blue scrubs, have never seen a 'hood'
    -mask are only worn if the surgeon insists-they teach us over here that the usefulness of masks is doubted
    Sterility rules
    -As a student, I have helped set out the tray type thing, so we reached over it then, unscrubbed, to drop things onto the tray. Sterile things are always green, and clear plastic is sterile if its in somewhere that is likely to be sterile (ie covering buttons on a machine that is going to be used by the doctor during the operation is sterile, attached to the system for holding the bags for each pt's rubbish and everything, or over the bowl-not sterile)
    -not yet come across radiation in theatre, but when I attended an x-ray we just stood behind a screen
    Misc rules
    -Pleanty of places to step out to (if you can get there!) like the scrub room, clean utility or dirty utility
    -I stood right behind the assissting dr. when I went to theatre on my last ward to watch a TAH BSO, and I was unscrubbed and I'd hasked the permission of the Sister
    -have nerver asked the pt's permission to watch their operation, and have never asked the nurse if I'm allowed to speak to her pt (not in theatre-I mean on the wards-I wouldn't dream of sitting there and having a conversation with a pt under local during the oepration!)
    -Same I guess with the pt's chart, but the only time I've looked at them is on the wards doing BPs, just read care plans for all the pts on the ward though
    -We fail essays/exams if put a pt's name in and do not say the name's made up due to NMC confidentiality and that
    -When I watched the TAH BSO, the anaesthetist stood next to em and chatted away during the operation, whilst he drank his coffee!, and I have never asked permission to ask questions-just use my common sense and don't ask questions in front of pts that could scare them
    -I had to sign in and out of theatre when I was there with eyes
    I've got a 6 week theatre placement coming up soon
    I think it's amazing the differences between healthcare in the USA and over here in the UK
  4. by   core0
    Quote from not now
    [/list]When I was in my second sememster I was watching a procedure...dear God I can't even remember what it was. Anyway, the doctor had already started and forgot to put on his lead. Since I was the student and just standing there with lead on he would stop, walk around behind me (not close enough to touch), let them X-ray and then walk back around me.
    We used to use IV poles with an apron on it and then a sterile mayo cover over it. Just hide behind that on a long case or if someone decides they need C-arm after the case starts.

    David Carpenter, PA-C
  5. by   lovejana22
    thank you so much for these. i have printed them off and will be making sure i follow every one of these.
  6. by   beth66335
    Hey, if you have smelled C-diff, 'stomies, gangrene, old urine, vomit of all kinds, the breath of a nursing home patient that never has his teeth brushed, you can handle any smell!
  7. by   applemae
    [s]thanks a lot![/s]
    Quote from Marie_LPN
    A couple of tips and such to help:

    Dress Code:
    • Give some serious thought into what attire you will wear into that dept. if you're allowed to wear something other than your clinical outfit on your OR day. I wouldn't have even thought to mention this, except last Friday, we had some airheaded student who wore a belly shirt, very low rise jeans with rips in them, with her G-string 4 or 5 inches above the waistband of her pants, and, yes, stilettos. This was our first impression of this student. She looked like she was ready for amateur night at a club in Richmond.
    • About perfume: it's called cologne, not marinade, so make the scent a minimum, not something that people can taste. Pts. are sensitive to things like that.
    • Change into OR scrubs first thing when you get there, AFTER letting the charge nurse know who are, what school you're with, and such. This includes a long sleeved jacket. It's cold in there, you'll need it.
    • WEAR YOUR NAMETAG. To us, you're a suspicious looking stranger w/o your nametag. Cannot believe that this isn't more enforced in schools to wear your tag.
    • Shoe covers are to be worn at all times when in the OR. Change them every time you go into another case.
    • Hats are to be worn at all times in the OR. All hair must be covered, and cover earrings as well. If observing in cases such as total joint replacements, spinal surgeries, or anything that's got a laminar flow air system that's running, you must wear a second head covering that is a full hat that ties around the bottom of your neck (nickname a "hood" by some of the staff). The first hat should be covered completely by this hood.
    • Masks are to be worn at all times when in the operating rooms. They must be form fitted to your face and both sets of string tied, no exceptions. Change mask each time you go to another case. It is also suggested that if you are allowed to stand close to the procedure, wear eye protection, things can splash, even on the simple cases.
    • Isolation masks that are for MRSA and VRE protection (the yellow kind typically) are NOT approved for OR level filtration. Do NOT wear those in the OR. (It's, what, September 4th, 2006 right now, and we've already seen 8 students attempt to wear these masks in our ORs. We don't even have them on our floor, so who knows where they came from.)
    • If the pt. is suspect of TB,you will be required to wear the N-95 respirator mask (). Where i work, we actually recommend that students avoid a room with a TB pt. though (the less people in the room, the better).
    Sterility Rules:
    • The standard rule: if it's blue, don't touch it. Everything blue is sterile. Don't even reach over any sterile field for any reason (i've had this happen a couple of times, when a student pointed to something on the table and pointed OVER the field more than once, and i wound up asking her to leave the room as a result, i could not risk a break in sterility. NO NO NO.) . If you have any questions about what is sterile, assume it IS sterile and treat it as such until you can ask about it.
    • Clear plastic in the OR is also sterile.
    Radiation Protection:
    • You need to wear lead aprons and thyroid shields when observing OR cases with X-ray. While wearing the lead aprons, never turn your back to the X-ray machine. If no lead is available for you (which is typical on heavy case days, step out of the room during the X-raying or stand behind someone who had lead on).
    • Do not fold the lead apron in half or drop it to the floor. This breaks the lead, causing it to be ineffective.
    Misc. Rules:
    • Eat a good breakfast that morning. I don't mean an energy bar, i mean eggs, sausage, OJ and toast.
    • Anything of value has a habit of growing legs and walking off from the locker room. I recommend only bringing a couple of pens, your nametag, and a notepad, and leaving your other clinical things out in the car.
    • No food in the OR. Yes, the docs might be dragging their coffee cup in, but as the rule goes, do as they say, not as they do.
    • Television is not reality. Just because the actors do certain things on their shows doesn't mean it's correct technique. (and probably the biggest reason why i can't stand any of the medical dramas)
    • Don't lock your knees while watching. Step around a little bit, even if you don't have much room to move.
    • If you feel weak, step out. If you're in a total joint room and aren't "allowed" to leave, at least sit down. And if you are allowed to leave a TJ room, chances are you can't come back in, because of infection control.
    • If the smell is overwhelming (and there's a high possibility of this), bring alcohol swabs with you. Poke on inside of your mask when needed. VapoRub inside of the mask has the same effect, but the alcohol swabs are everywhere.
    • Always ask the permission of the pt., nurse, and doctor before going in the room. Do not just assume that you're allowed. Pt. privacy is always respected, first and foremost. The circulator is the pt. advocate. Always check with the nurse before interacting with the pt. (Already, in Sept. 2006 at our facility, this has had to be reinforced)
    • Ask the pt.'s nurse, then the pt. before looking at the pt.'s chart. To do so w/o permission could get you in a position where you will be asked to leave the room, and quite possibly the unit, for privacy violations (seen it happen more than once).
    • When talking to the pt., try to talk to them in a lowered voice. Privacy, again. No one else needs to hear about Mr. Smith's 'rhoids, and it's probably safe to say that no one would want to either.
    • Do not take offense if the doctors don't talk to you. They are concentrating on the situation at hand.
    • On the other hand, there are plenty that DO like to teach.
    • If you're taking notes on anything, refrain from using pt. name, or MR number. Identify your pt. as, for example "56 y.o M h/o yadayada. It's actually best if you leave ALL names off your paperwork.
    • I don't suggest asking anesthesia questions until AFTER the pt. is intubated, the tube is secured and connected to the circuit, the anesthesiologist isn't touching the pt., and/or they have sat down in their chair. And ask if it's OK to ask questions about what they did/are doing. Don't just assume it's OK to do.
    • Also, before asking the surgeon any case-related questions before, during, or after the case, ask them if it IS OK to ask questions.
    • Chances are, when you're in a room, you have NO idea where to stand to watch. We don't even know where you should stand till the pt. is draped and everything is arrange. The safest bet is to stand up against the wall out of the way, and wait. Chances are, the circulator will point out a good place to stand.
    • OR scrub staff will typically not talk to you during a case. We're trying to listen to what the surgeon says, and it's hard to hear a mumbling doctor when we're talking and listening to someone else.
    • A great way to insult and offend OR staff is ask if they are a "gopher." Or say "This is boring" over and over. Think about it, how would you feel if someone came to your job and said "this is boring" for 8 hours?
    • If you're there with a fellow student, be careful of your conversation. Keep it clean and professional. I say this because yesterday we had 2 students from the same clinical group describing in a normal tone of voice the prior weekend's frat parties, and let's just say it was overheard how one of them made a few football team players "happy" that night, and made me suddenly feel the need to brush and floss my teeth.
    • Assume that anything laying on the floor is filthy and dirty. If you touch anything that might have touched the pt., go wash your hands with soap and water. If the nurse tells you to wash your hands, do it. They're telling you to do so for your own safety (ex. we dropped a sponge on the floor, student picked it up, i immediately told her to wash her hands in a quiet voice, then told her why).
    • Never forget HIPAA! You may be required to sign an agreement for privacy before you are allowed to observe.
    If i think of anything else, i'll add it on this post.:hatparty:
    this is great! it really helped a lot, though i know some of those.. its really amazing that you manage to post something like this! im a graduating student and been exposing majority on O.R.'s this is a great help! thanks!
  8. by   aziah
    what is holistic approach to a dying patient ?
  9. by   Aedana
    Very well said, Marie. :-) I think you forgot one more rule: Always keep your sense of humor. :-)

    A fellow student (who works as a surgical tech) and I observed a C-Section. The nurse reviewed the importance of sterility, blue fields, not touching anything without asking, etc.

    After completing the mini lecture, she loudly and emphatically told the other nurses to keep an eye on us students to prevent us from violating the sterile fields. Finally, with a grand gesture, she opened up what looked like a chuk. As the chuk unfolded, it tore. *FoOf* A geyser of fluffy chuk innards spewed EVERYWHERE, floating all over the entire OR theater, pretty much violating any and every sterile field in the room.

    Needless to say, everyone was horrified and it was a mad dash to the next room to re-prep. We were fortunate there was a clean room available so what could have been a terrible situation turned out ok. Mom safely delivered a beautiful baby. But the other student and I did chuckle after the day was over at the irony of the situation where the nurse teaching us was the bigger violator of sterile fields than any of us students present. :-)
    Last edit by Aedana on Jul 23, '07
  10. by   second career nurse
    Very interesting material. I am about to begin nursing school, so I never thought of most of what you said, before now.
  11. by   smiles04
    Quote from Mave
    I gotta say, the tips are wonderful, but IT SCARES THE CRAP OUT ME!!! I'm afraid I will faint, touch something I'm not supposed to or just simply screw up! Phew!!!!
    After reading that oiginal thread I was afraid some of you green guys might be a little terrified. It was vry good info no doubt but please STUDENTS REMEMBER YOUR STUDENTS AND EVERYONE KNOWS THAT IN THE OR BECAUSE YOU LOOK GREEN. Its really great if you can find a OR nurse recording that might be able to give you some teaching and info quietly. Many surgeons love to teach but also will mess with you and ask you some beefy questions. Suprise them and know what your talking about. Definitely dont lock your knees standing and do eat. Sometimes these surgeries give you a reaction your not expecting. Sometimes you have to leave, sometimes you'll find you LOVE it. I recommed you guys not take a ortho replacement or amputation the first time. Things are flying. Open heart is amazing to watch its truely a miricle to see. REMEMBER guys we use lazer now alot, so the blood is nothing like old tv shows. Also those of you who like surgeries C SECTIONS are amazing too. The layers of tissue and shazzam baby, is fantastic.


    I HOPE I GAVE YOU GUYS A DIFFERENT TAKE ON SURGERY. YES ITS INTRICATE, AND SERIOUS, BUT AWESOME AND VERY VERY INTERESTING. SEE AS MANY DIFFERENT SURGERIES AS POSSIBLE.

    YES OR SURGEONS AND NURSES ARE VERY SPECIAL BUT REMEMBER WE ARE ALL PEOPLE AND THATS IT. WE JUST ALL HAVE DIFFERENT TALENTS TO SHARE FIND A GOOD TEACHER IN THERE. MOST OR NURSES LOVE WHAT THEY DO.

    TAKE CARE AND GOOD LUCK ENJOY IT AND REALIZE YOU WILL COME OUT EXCITED AND IN POST CONFERENCE YOU'LL BE SHARING WONDERFUL EXPERIENCES.
  12. by   smiles04
    Quote from Mave
    I gotta say, the tips are wonderful, but IT SCARES THE CRAP OUT ME!!! I'm afraid I will faint, touch something I'm not supposed to or just simply screw up! Phew!!!!
    After reading that oiginal thread I was afraid some of you green guys might be a little terrified. It was vry good info no doubt but please STUDENTS REMEMBER YOUR STUDENTS AND EVERYONE KNOWS THAT IN THE OR BECAUSE YOU LOOK GREEN. Its really great if you can find a OR nurse recording that might be able to give you some teaching and info quietly. Many surgeons love to teach but also will mess with you and ask you some beefy questions. Suprise them and know what your talking about. Definitely dont lock your knees standing and do eat. Sometimes these surgeries give you a reaction your not expecting. Sometimes you have to leave, sometimes you'll find you LOVE it. I recommed you guys not take a ortho replacement or amputation the first time. Things are flying. Open heart is amazing to watch its truely a miricle to see. REMEMBER guys we use lazer now alot, so the blood is nothing like old tv shows. Also those of you who like surgeries C SECTIONS are amazing too. The layers of tissue and shazzam baby, is fantastic.


    I HOPE I GAVE YOU GUYS A DIFFERENT TAKE ON SURGERY. YES ITS INTRICATE, AND SERIOUS, BUT AWESOME AND VERY VERY INTERESTING. SEE AS MANY DIFFERENT SURGERIES AS POSSIBLE.

    YES OR SURGEONS AND NURSES ARE VERY SPECIAL BUT REMEMBER WE ARE ALL PEOPLE AND THATS IT. WE JUST ALL HAVE DIFFERENT TALENTS TO SHARE FIND A GOOD TEACHER IN THERE. MOST OR NURSES LOVE WHAT THEY DO.

    TAKE CARE AND GOOD LUCK ENJOY IT AND REALIZE YOU WILL COME OUT EXCITED AND IN POST CONFERENCE YOU'LL BE SHARING WONDERFUL EXPERIENCES.
  13. by   jjmath215
    Hi everybody! I did my OR day last friday and I thought it was wonderful! I picked the last day that was availble so it was a wonderful break from clinical. Everybody was pleaseant and helpful. I did notice that they made fun of the patient while they were under. All my peers said the same thing. Is it me or is there just something wrong with this? Anyway, relax, enjoy the break from the floor and learn something!!

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