Communication is the backbone of progress. To adapt, change, or develop requires incorporating the spirit and artful skills of communication into every step of a plan. As perioperative nurses, we realize the value of communication as we attempt to explain the importance of the nursing care role to administrators, legislators, students, peers, and others who query our roles and responsibilities. Nurses assess, interpret, make decisions, and evaluate daily as they implement care. They coordinate, collaborate, and optimize while working to establish a trusting and caring environment with team members. Translating those activities into words that describe patient care and that can be quantified and used to explain what a perioperative nurse does each day without offering an endless list of tasks is the ultimate challenge.

Describing perioperative patient care is difficult for many reasons, including that activities occur within restricted time frames and result from decisions and monitoring by many people at once. Even nurses who realize and believe that nursing is an important component of the care continuum during surgical and other invasive procedures have difficulty understanding and explaining how their roles, responsibilities, and nursing care activities are integrated in a highly technical environment. Overcoming various interpretations, role confusion, and inconsistent use of language, when also attempting to compare and measure nursing care, requires a common spoken and written language and consistent messages.

LEARNING THE LANGUAGE

When someone asks what care perioperative nurses provide, the first instinct is to describe tasks. Easy responses might include “assist the surgeon” or “ensure that supplies and equipment are ready and working.” These responses send a message to others about the value of the intraoperative nurse in patient care roles. They also confuse the issue when other health care providers claim that they are providing the same care and participating in the same activities.

The challenge is to identify the best way to describe the patient’s problems and associated care using nursing language, not a list of tasks. The language must be consistent with the knowledge necessary to determine patient needs associated with the task. For example, applying an electrosurgical dispersive pad is considered an intraoperative task. It is performed several times each day in many locations where surgical procedures take place, usually without adverse outcomes. Translating that task into nursing language requires understanding the equipment’s use and function, as well as patient needs associated with using electrosurgical units (ESU) and associated devices. Applying the electrosurgical pad seems to be a routine, harmless activity because of the warning signals built into the equipment and guidelines for its use (eg, presence of implants, appropriate pad size, presence of muscle tissue, absence of scarring, proximity to the incision). We even make it seem harmless by spending very little time discussing the ESU during orientation. After all, what does a person need to know about applying an electrosurgical dispersive pad when it is so easy?

Information and knowledge needed to use the ESU is more comprehensive than it seems and should not be taken for granted. Patient considerations, such as compromised skin and tissue integrity (eg, dryness, scaling, excess sweating, lesions), a procedure that might vary from the standard approach (eg, different incision, different skin prep site), or changing positions throughout the procedure, can be identified during the nursing assessment and result in. patient-specific interventions and evaluations to prevent adverse outcomes associated with the task. This requires nursing assessment, as well as knowledge of the equipment and its function. What other person in the room has this understanding?

There is an unlimited number of tasks that can be identified and associated with nursing knowledge. Applying compression devices, tourniquets, or dressings; using positioning devices; monitoring urinary output; having safety equipment available; preparing equipment for a difficult intubation; decreasing the length of surgical procedures; and classifying wounds are activities managed every day by care providers who do their jobs without thinking about how they are preventing adverse outcomes because of the knowledge they provide during patient care. Nursing knowledge plays a role in these and many other responsibilities in health care settings.

OVERCOMING COMMUNICATION BARRIERS

Nursing language is not new. Every educational program attempts to help students understand and use the nursing process; however, when students select an OR career, the language changes from one of assessment, diagnosis, intervention, evaluation, and outcomes to one that revolves around a medical diagnosis and surgical procedures. Those of us who learned perioperative patient care understand this because proving oneself in an OR means efficiently and effectively doing multiple tasks with minimal direction or assistance. In the eyes of team members, however, this may mean that completing tasks is seen as comparable to providing nursing, care.