Design and Health World Health Design

Health Record: Theatre Of Care

The work within a surgical department is often demanding for nursing staff, who have limited control over the design, quality and performance of their environment, reflects Irini Antoniadou.

A crude, but useful, way of understanding the working environment is to consider it within a physical and a psychological context. Both are significant in relation to their impact on the performance and the well-being of the operating room nurse. And a stressed or underperforming nurse is a threat to a patient’s human right to safe and good care.

After 24 years as a Swedish operating room nurse, I am well placed to reflect on the many types of environments within the medical service I have had the opportunity to work within – ranging from good and the bad to the ugly. But what is a Swedish surgical department like? Typically, patients will arrive in a large waiting room, often lacking in seclusion and privacy. Thereafter, they are transported along long and barren corridors before arriving at the operating theatre.

Bare and inhospitable with stark lighting, the operating room is filled with technical equipment and monitors, which are necessary for the patient’s care and safety. While they are waiting for the operation, there is little for the patient to rest their eyes on, in an unfamiliar environment that is certainly stressful, and occasionally, frightening – a highly clinical space with bare walls, strong lighting and nursing and medical staff working at a high pace in blue or green clothes, caps and masks.

Lately, I have thought about how patients experience the operating theatre environment and its impact on their well-being. I have also considered how the features of the physical surroundings could be changed, to create a less stressful experience that promotes the health of both the patient and the staff. In addition, for the operating theatre nurse, creating an environment that supports our own well-being is essential, both as a support to our caring work and to reduce patient anxiety.

The operating room nurse’s work is demanding, with a significant responsibility for patient care. Yet, with ever-rising pressure on productivity, there is seldom time to relax, other than a brief break in a crowded staff room or a snatched bite to eat for lunch. It is also rare to enjoy the opportunity for a pleasant and reflective conversation in staff rooms that are often noisy and lacking in windows – artificially lit with minimal access to daylight.

One surgical department I worked in did offer staff a room in which they could relax after finishing their meal. The lighting, however, was poor, consisting of little more than a lamp in the corner for reading a book or magazine. A sofa provided an opportunity to rest aching muscles and tired eyes, but the computers which were used by many of the staff during their lunchbreak, meant the room was not sufficiently peaceful and quiet to allow for real relaxation and recuperation.

Yet, simple improvements to the environment can quickly and easily be made at little expense. The creation of an attractive symbiosis between light and colours in the hospital’s surroundings, for example, would make the daily ward round a more pleasant experience, improving the level of nursing care and helping to relax the patient.

I have often reflected on the impact on patient care of my fatigued physiological state after a long shift in the surgical department, with no access to natural daylight. It is a recurring theme and issue amongst many operating nurse professionals.

In Sweden, the law concerning health and medical care recognises that staff, room and equipment are all essential components in ensuring that the patient receives good and safe care. So, what do we need to do to create a physical milieu which supports care in the operating room by creating positive effects on the patient’s well-being?

This is a critical debate across the different nursing and medical professions in the surgical department. An environment designed to support both well-being and function energises staff psychologically and spiritually, thereby creating the optimal conditions for high quality care delivered in a humane way.

Swedish health and medical care law. Hälso-och sjukvårdslagen [HSL] (SFS 1982:763).

Author: Irini Antoniadou, RN, ORN, SocBsc, BscN is a university lecturer and president of the European Operating Room Nurses Association (EORNA). This article is a personal view and does not necessarily reflect the position of EORNA.

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