COVID-19 is an emerging, rapidly evolving situation. Hiding in plain sight: communication theory in implementation science. In the following exchange, a nurse wants to verify whether a patient has been ‘prepped’ (prepared) for surgery. 2. She does not verbalize this uncertainty, even after two requests for her to perform an action: Surgeon asks for insufflation of the patient’s abdomen. Instances of communication characterized by unresolved or unarticulated issues were identified in field notes and analysed from a critical ethnography perspective. How we approach and train for interprofessional collaboration should incorporate an awareness of the complex strategies and modalities of communication, including silence, employed in the operating room setting. Similarly, we investigate that which remains unresolved or unarticulated in OR communication by examining the interplay between speech and silence. A few seconds later the request is repeated. Commentary: Communication: The Most Important “Procedure” in Healthcare and Bioethics. In this example, there is a pattern of lack of response to nurses’ questions evident through exchanges about two different topics occurring a few minutes apart. The nurse asks if the surgeon is not in the OR, perhaps to clarify why the resident is not asking the surgeon about arm positioning. How will the nurse be perceived by colleagues from his/her own and other professions? The performative aspect of speech relates to speech that attempts to accomplish an action, and can ‘fail’ or ‘succeed’ or be more or less efficacious in accomplishing that action. A Surgical Team Simulation to Improve Teamwork and Communication acrossTwo Continents: ViSIOT Proof-of-Concept Study. Thus, the OR teams we observed were characterized by a core of general surgeons, with a larger core of nurses who worked in general surgery, anaesthesiologists who worked in multiple services, trainees on rotation, occasional nursing staff from other services and sometimes anaesthesiologists from other hospitals. Knowledge and agency in interprofessional care: How nurses contribute to the case-construction in an Intensive Care Unit. Trauma team leaders’ non-verbal communication: video registration during trauma team training. In the following example, there appears to be a level of tension felt by the scrub nurse in speaking, such that she repeatedly performs a complicated physical manoeuvre, rather than giving a brief oral instruction to the surgical team, which the surgeon repeatedly invites her to provide: This communication event takes place over a 45 minute period. Circulating nurse: ‘They want to ignore us. I’m not sure’. These are processes of power that clearly produce silence and constrained communication. FG was responsible for the drafting of the manuscript. However, beginning in the 1960s, emphasis in the literature shifted to the role of silence as a form of communication within the therapeutic alliance. In this interpretation, we can see an example of the potential interplay between speech and silence, as the nurse’s frustration with the surgical trainees’ non‐responses may inhibit future communication. Reflective activity 'How to' articles can help to update your practice and ensure it remains evidence based. OPUS Uluslararası Toplum Araştırmaları Dergisi. Nurse/Physician Communication Through a Sensemaking Lens. The shared silence between a patient and a nurse creates a common bond and may strengthen the relationship. 2008). The circulating nurse records this diagnosis on the operative record. SILENCE IS POWER With the caveat that power can always be abused, the effective use of silence can bestow many gifts, chief among them: The ability to … Most importantly, why are some speakers hesitant, tense, reticent and not entirely audible, while others are confident, at ease, gregarious and perfectly audible, if not in fact loud? Preventable Surgical Harm in Gynecologic Oncology: Optimizing Quality and Patient Safety. The capacity to bear witness and respond empathically to a dying person’s suffering is inherent in end-of-life care. » Intentional silence can be used to reduce the patient's emotional lability by ensuring that they feel listened to. Attention to the complexity of silence in the OR is also essential in the context of increasing movements in health care to ‘foster’ collaboration and ‘improve’ communication in clinical team settings. Our research supports the finding of other OR ethnographies that the need for nurses to demonstrate competence, often through the ability silently to anticipate surgeons’ needs and preferences, can impede interprofessional communication (Riley & Manias 2005, 2006, Gillespie et al. Therefore, explicit attention to silence may be seen as a way of attending to the voices of those with less power. These silences may be defensive or strategic, and they may be influenced by larger institutional and structural power dynamics as well as by the immediate situational context. Methods. The back‐and‐forth exchange suggests a challenge on the part of the nurse and resistance from the surgeon to being questioned. However, unlike other research, we also consider silences on the part of other OR professionals, and suggest that silences on the part of nurses and others can be expressive rather than inexpressive, strategic rather than simply defensive. 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