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ABSTRACT
A concept analysis was performed on surgical conscience in perioperative nursing using the Penrod and Hupcey principle-based method. The analysis included framing surgical conscience according to the epistemological, pragmatic, linguistic, and logical principles and showed that surgical conscience falls into several domains, including nursing, surgery, anesthesiology, surgical technology, and interventional radiology. Although some perioperative nurses consider surgical conscience a fundamental principle in the OR, there is limited published literature on how surgical conscience is introduced, learned, improved, or measured. The literature search for this concept analysis did not produce a published operationalization of the concept. Therefore, this concept analysis provides a comprehensive definition of surgical conscience to guide the future research that is needed to reinforce surgical conscience and prevent conceptual dogma-a situation in which attributes of a concept lack the support of additional investigation but are still used and reinforced over time.
Key words: concept analysis, surgical conscience, principle-based model, moral courage, ethical perioperative practice.
Perioperative nurses have defined surgical conscience as advocating and defending perioperative safety protocols (eg, surgical asepsis) regardless of consequences and cost.1 They routinely face ethical dilemmas during their practice because they care for patients who are in a highly vulnerable state.2 The perioperative environment is dynamic and complex, often requiring nurses to demonstrate moral courage3 and make difficult decisions under pressure.4 Results of a 2015 survey of 248 nurses in Japan showed that 47 (37.9%) of 124 nurses who scrubbed and 38 (30.6%) of 124 nurses who circulated felt mentally stressed during surgical procedures.5 The researchers noted that they expected this finding because the OR is a high-risk environment with the potential for adverse events. In addition, the nurses were concerned about teamwork performance; the stress that they experienced may have prevented them from exercising surgical conscience and thereby negatively affected surgical outcomes.5
Possible reasons for why a perioperative nurse may not feel empowered to speak up include a perceived hierarchy in the OR,6 a facility's culture,3,6 navigating challenging personalities (ie, person-related stress),6 and a fear of retribution.3 Lack of empowerment extends to possible deviations from infection prevention and control protocols,7 including failing to practice the highest level of aseptic technique. Researchers have studied perioperative safety and made efforts to alleviate safety deficits and improve surgical outcomes.8