A surgical conscience may simply be stated as a surgical Golden Rule: Do unto the patient as you would have others do unto you. The caregiver should consider each patient as himself or herself or a loved one. Surgical conscience involves a concept of self-inspection coupled with moral obligation. It incorporates the caregiver’s values and attitudes at a conscious level and monitors behavior and decision-making in relation to those values. In short, a surgical conscience is the inner voice for conscientious practice of asepsis and sterile technique at all times. (Ross, 2008) Honesty is a major ethical standard. It is more important to admit that a procedure or activity is unfamiliar than to proceed blindly in order to save face. The operating room nurse or any staff member must be honest about his or her own capabilities so that error can be reduced. (Ross, 2008) A "surgical conscience" is the foundation upon which the skill and techniques employed by the OR specialist are built (Osman, C. 2000). He must know the principles of sterile technique and he must apply them. Breaks in technique may allow the entrance of infectious organisms that the tissues cannot destroy. Even a so-called "mild" infection will delay a patient's recovery and a "mild" infection may quickly become a severe one. Thus, any infection is potentially a threat to the life of a patient. The OR specialist should be acutely aware that there is no substitute for sterile technique and he should, therefore, follow the principles of such technique painstakingly. The specialist, and all other team members, should never be reluctant to admit a possible break in technique, even if there is doubt about it. Any part of the sterile field, including the sterile gowns and gloves of team members, should be replaced with fresh, sterile items if any doubt arises as to their sterility. In the operating room, staffs have assignments so that those who have undergone surgical scrub and donning of sterile garb are positioned closer to the patient. Other "unscrubbed" staff members are assigned to the perimeter and remain on hand to obtain supplies, acquire assistance, and facilitate communication with outside personnel. Unscrubbed personnel may relay equipment to scrubbed personnel only in a way that preserves the sterile field. For example, an unscrubbed nurse may open a package of forceps in sterile fashion so that he or she never touches the sterilized inside portion, the scrubbed staff or the sterile field. The uncontaminated item may either be picked up by a scrubbed staff member or carefully placed on to the sterile field. (Potter and Perry, 2000) It was essential for the nurses to have confirmation by patients, colleagues and their conscience that they were doing their utmost, although they could never be certain about the correct and best thing to do in particular situations. They found ethical problems easier to live with as more experienced as they had acquired skills that made them more equipped to deal with them; and to anticipate what might happen. The recollection of former patients, especially successful cases of unexpected recovery, increased nurses’ strength to carry on with their work in the unit and in the nursing profession. (Girard, 2007). There are many definitions of surgical conscience, most of which reject use of aseptic technique and maintenance of infection control measures. “As advocates for the patient, the circulating nurse and every other member of the patient care team must maintain both an individual and collective surgical conscience” (Phippen, Ulmer & Wells, 2009, p.221). Acting on personal surgical conscience involves knowledge, self-awareness, intelligence, and the courage to make ethical and moral decisions that benefit the patient (Girard, 2007). As procedures involving aseptic technique can take place in areas outside the perioperative department (e.g., Cesarean sections in labor and delivery, bedside...
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