SCHOLARSHIP INFO:
We still have funds available for scholarships. Instructors contact AZSA for more information.
Or apply for one of the many AST scholarships at:
http://www.ast.org/educators/scholarships.aspx
AZSA is trying to set up a mentoring program for students in need of extra help. Our education committee will try to get you a CST in your area to mentor you if one is available.
If you did not attend or graduate from a CAAHEP accreditated school and want to become certified this is the link for info for an online program that prepares you to sit for the national exam:
AST Accreditated School Information
http://www.ast.org/educators/accreditation.aspx
Local educational websites and info
EVIT http://www.evit.com
Pima College
http://www.pima.edu
Mohave College
http://www.mohave.edu/pages/1.asp
Gateway College
http://gatewaycc.edu
STUDENT ARTICLES
Understanding Surgical Conscience
Bobbi Harrington
Surgical Technology, Mohave Community College
Abstract
Provide definition and examples of the concept, principles and use of Surgical Conscience as it pertains to the Surgical Technologist.
“He who through anxiety of conscience busies himself in drawing out the good or evil motives of his manifest actions, who sees vices and virtues at their birth, who follows the insensible progress of culpable thought and the secret confirmation of good resolves, who can work the force, nature, and moment of temptation and resistances, holds in his hand almost all the moving strings of humanity, and has only to make them vibrate regularly to draw from them the most powerful harmonies.” (Evans, 1950)
That was an excerpt from the August 1950 edition of Annals of Surgery, describing the need and importance of Surgical Conscience in those ‘modern’ times. For those of us who were raised in the more recent decades, unaccustomed to such elegant prose and artful vernacular, a layman’s definition may still be necessary. In the text books, Surgical Conscience is essentially defined as ‘the ethical motivation to practice strict aseptic technique to protect the patient from infection’. Even such a frank definition fails to convey the importance of integrating a strong Surgical Conscience into the fibers of every action of medical personnel. In order to make the concept of Surgical Conscience painfully clear, it could best be elaborated on in general, every-day actions or experiences that any person can understand and relate to.
Evan Findlay, author of PeriOperative Patient Care, provides five guidelines for developing and maintaining Surgical Conscience.
Developing a surgical conscience requires:
1. Knowledge of the principles of asepsis.
2. Self-discipline in inspecting and regulating one’s own hygiene, dress and nursing practice with attention to breaks in technique.
3. Ability to anticipate the need for supplies and services based on knowledge of the patient, the procedure being performed, the preferences of the surgical team, and where and how to obtain supplies.
4. Good communication skills to determine the needs of patient and team members and to identify and correct breaks in technique.
5. Maturity to overcome personal preference and prejudice to provide optimal patient care, regardless of the operative procedure, the patient’s circumstances, or other perioperative personnel. (Findlay, 1983)
In step number one, ‘knowledge of the principles of asepsis’, it is imperative that the importance of sterility is thoroughly understood by all individuals that will be in/near the sterile field. Much like any civil law, the excuse of “I didn’t know any better” will not shield a person from fault after an incident. In the realm of medicine, a simple misstep concerning asepsis can bear life threatening consequences, much like an innocuous gaffe on a tax return may be punishable by criminal law. If one does not understand tax codes, they should not take it upon themselves to complete their own return and risk breaking federal laws they may have been unaware of. On the same coin, if a person does not fully understand the principles of asepsis, they should refrain from entering an environment where asepsis is essential.
Step number two, ‘Self-discipline in inspecting and regulating one’s own hygiene, dress and nursing practice with attention to breaks in technique’, may seem relatively straight forward, but the scope of this rule has many facets. In any field, basic hygiene may seem like a ‘no-brainer’, but it is not unheard of to encounter individuals with extreme body odor, unclean clothes, and grime covered hands in the workplace. Medical professionals will most likely be aware of their level of cleanliness, but a strong Surgical Conscience will highlight minute areas of hygiene that the average person may not consider, such as maintaining the length and condition of fingernails, limiting the application of fragrances and cosmetics, and the wearing of jewelry. The self-discipline to consider every action, weighing the possibilities of a break in asepsis, and choosing the options that are least likely to cause an incident, shows an understanding of Surgical Conscience.
The ‘ability to anticipate the need for supplies and services based on knowledge of the patient, the procedure being performed, the preferences of the surgical team, and where and how to obtain supplies’, step number three, is an ability that can only be honed with practice and attention to detail. When new parents bring home their newly born child, they may have a vague idea of what is needed to care for the infant, but, until they learn the nuances of their child’s needs and personality, they may feel insufficient and awkward in their responsibilities. After a few weeks, the parents will learn to translate the intonations in the child’s cry, understand the child’s preferences and be able to anticipate the needs and desires of the baby. Newly inducted medical personnel may go through a phase such as this, but will eventually learn the ropes of the who/why/what/ and where of their surgical team.
The fourth step, ‘good communication skills to determine the needs of patient and team members and to identify and correct breaks in technique’, ties in closely with the previous rule in the sense that one must be able to anticipate the needs of the surgical team. More important than thorough preparation prior to the start of a case, it is vital that the team member’s develop a sense of trust and dependability, to better allow them to convey their needs and concerns. When individuals have respect for one another, they are more likely to consider recommendations and act accordingly than if they dislike, distrust or misunderstand a person. For example, if a personal trainer uses negative reinforcement, the individual he/she is training may reject ideas and actions based solely on the delivery of the message. If the trainer can develop a method to convey the information in a way that allows the individual to retain their dignity, understand the importance or urgency of the message, and develop a plan that will satisfy the requirements, they will be more receptive to input.
One must also have the capability to relay negative information to a superior without degrading their stature. In a perfect working environment, higher ranking personnel would retain the humility to accept criticism or suggestions without seeing it as an affront to their pride, but, as that is not always the case, junior personnel must learn to approach a superior with professionalism and respect while clearly conveying the importance of their concerns. Relating to asepsis, each person concerned should have the fortitude to take a respectful stand when another person’s actions have or will compromise the integrity of the surgical field, regardless of the position held by the offender. A strong Surgical Conscience will ensure that one has the courage to intervene; whether that is to ask the other to elucidate on his actions in order to gently make them aware of their mistake, or plainly stating that an action may be inappropriate. For example, let’s say that you notice your tyrannical boss failed to secure the zipper on his pants after a trip to the restroom. You worry that he will use the affront to his pride as a weapon to attack you if you decide to politely mention it to him, but you could imagine how much worse the situation may become if you ignore the zipper and let him go about his day. Having the nerve to face the risk of igniting your boss’s anger in order to protect him is the civilian equivalent of Surgical Conscience. In an operating room setting, pointing out a small error on the part of a peer or a superior may be difficult, but a few moments of tension is preferable to later realizing your lack of action caused a loss of asepsis.
The final guideline for developing surgical conscience may be the most important, and can be expanded on extensively; ‘Maturity to overcome personal preference and prejudice to provide optimal patient care, regardless of the operative procedure, the patient’s circumstances, or other perioperative personnel’. In the simplest terms, this implies doing the right thing for the patient, no matter what. You must treat every case as if it’s the most important procedure in the history of medicine, be it the removal of an ingrown toenail or an organ transplant. Treat each surgeon as if he is a highly trained professional, even if he acts like a cantankerous Chihuahua. Most importantly, treat each patient as if they are the focus of your world, whether the patient is old or young, rich or poor, a convicted criminal or your own child. Your opinions have no bearing in the operating room, save for those that concern maintaining asepsis.
A medical professional’s Surgical Conscience must become an instinctive drive to perform with the highest level of integrity, despite the fact that there may be no one else around to witness the act, even if the event seems as if it would not affect the outcome of the situation. Employing a strong Surgical Conscience entails performing all tasks in the same manner you would if you were under constant supervision, treating patients and co-workers with the utmost respect and performing at the height of your abilities on every occasion.
References
Evans, E.I. (1950). The surgical conscience. Annals of Surgery, 132 (2), 315 http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1616565&pageindex=1#page
Findlay, P (1983). Perioperative patient care. Jones & Bartlett Publishing
My Life as a Scrub Tech Student
Going to Surgical Tech school was one of the most difficult endeavors I have taken on so far in my life and despite its difficulty has turned out to be one of the most rewarding things I’ve ever done. I had just finished high school and needed direction in my life and I luckily stumbled upon the Surgical Tech program at my local community college and I am so thankful that I did.
I knew I had a long road ahead of me when I signed up for class at the college. I found out classes were in another town an hour way. At first it seemed so daunting but I was determined. My next stop was the college book store where the enormous stack of books handed to me made my eyes bulge and made me think “how was I going to do this.” Despite these shocks I was still determined to enter and succeed in this program. I knew it was going to be tough juggling class, work, and study time.
The first day of class I made that hour drive hauling my back pack full of books wondering what I was getting myself into. I sat down and our instructor told us our curriculum and that we wouldn’t have time for anything but eating, sleeping, and studying. I somehow managed to get all my assignments done on time and make that hour drive everyday. Things got a little more difficult when we started our fall clinicals and we had to make that hour drive every morning to be at the hospital at 7am. There were times I couldn’t believe I made that drive alive. I managed to get through it but our instructor was right I came home ate, studied, and went to bed every night and all while working part time at Papa Murphy’s Pizza.
In spring semester our clinicals moved to the town I lived in and I started to scrub in and actually tech cases. I had my good days and my bad days, all while still making it to class an hour away twice a week. All my hard work paid off when I graduated that May and I managed to make the President’s List at the college. Despite all the good times I still had my summer semester to go. It consisted of clinicals four times a week. Monday through Thursday I would do clinicals till
3 pm then go home and write up every case I teched that day, Fridays I caught up all the write ups I was too tired to do during the week and the weekend I worked at my minimum wage pizza job. Next thing I knew my boards were a week away and I had to review. A week solid of boards review, I felt like my head was going to explode. The following Monday I took my boards I felt that I did well but still kept my fingers crossed.
The rest of my summer I finished up my required cases and waited for my board results. I also applied at the hospital I was externing at and was hoping and praying they would offer me a job. My last day of clinical I was given an interview and they decided to hire me. On my first day of work I found that I had passed my boards, I somehow did it and I had become certified. I felt like a weight had been lifted. I had done it; I had become a Certified Surgical Technologist. All the long drives, long nights, and tired mornings paid off in the end and going to Surgical Tech school was smartest thing I have done so far.