Disagreement and Agression

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Richard Coe

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Disagreement and aggression in the operating theatre
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Dinah Gould

Accepted for publication 16 November 2007

Correspondence to R. Coe:

coE R.6. GOULD D. (2008) Disagreement and aggression in the operating theatre. ! oumaL of Aduanced Nur sing 61(6'), 609-578 doi: 10. 1 1 1 1/i.1365 -2648.2007.045 44.x

e-mail: richard.coe@uclh.nhs.uk Richard Coe MSc RN Senior Practice Facilitator (Thearres) Universiry College Hospital, London, UK Dinah Gould PhD RN RNT Professor of Applied Health St Bartholomew School of Nursing and Midwifery, Ciry University, London, UK

Abstract
Title. Disagreement and aggtession in the operating theatre Aim. This paper is a report of a study to determine the national spread of incidents of disagreement within and between professional groups in operadng departments and the frequency of perceived aggressive behaviour demonstrated by operating department personnel. Background. There is both anecdotal and empirical evidence supporting the idea of the operating team as the ultimate example of teamworking in health care. At the same time, international concern is expressed over the level of interprofessional

conflict and aggression reported in operating depanments, Such reports do not sit well with notions of excellence in teamwork as conceptualized by theorists. Method. A questionnaire survey was designed, and sent to a random sample of National Health Service operating departments in England (n = 62) in 2002. Usable survey questionnaires were returned from 37 departments (response rate 59'6) and yielded 391 individual responses. Respondents included nurses (587o, n=227), srugeons (9'7Yo, n = 38), anaesthetists (14'32% , n = 56) and operating department practitioners (17'9y", n = 70) of all grades' Findings. Half of the respondents reported experiencing aggressive behaviour from consultant surgeons (53'4y", n = 209), Daily disagreements between nurses and consultants about list management were reported. Perceptions of lack of understanding of roles and shared goals for patient care befween the professional groups were also reported. Similar repofis were received from all geographical locations in the sample.

Conclusion. Further research is needed to conceptualize the comPlex nature of interprofessional working in operating theatres before steps can be taken to develop a less stressful and more efGcient

working environment.

Keywords:. aggression, .orifli.r, interprofessional working, nursing, oPerating department, survey methods, teamworking

Introduction
The operating theatre has been described as the ultimate example_of multiprofessional teamworking in health care (Gorman 1998). However, anecdotal and empirical evidence have demonstrated concern at international level over @ 2007

reported disagreement and aggression between professional groups in relation to the way oPerating lists are run (Dunn 2003, Firth-Cozens 2004, Lingard et aL.2002,2004, Moss 6c Xiao 2004). The siruadon is of particular concern in the United Kingdom (UK), where the need to increase efficiency

in

operating rheatres has been the topic

of

numerous

The Authors. Journal compilation @ 2007 Blackwell Publishing Ltd

R, Coe and D, Gould'

initiatives at government [National Health Service (NHS)
Modernisation Agency 2007,2002, Audit Commission 2003, 2002) and local level (The Association of Anaesthetists of Great Britain and Ireland 2003), with a specific focus on financial and waiting list objectives.

both physical and collaborative senses. It has been suggested

Background
The stressful nature of healthcare work has been widely
acknowledged (Almost 2006, Ashworth 2000, r0flarr 1990, Farrell 79971. Frequently identified contributory facors have included: high workload (Iileinberg Et Creed 2000), management style (Beardwood et a\.1999, Laschinger et al. 19991

that the iuxaposition of the...
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