Barriers to Surgical Conscience Action Scale

Self Assessment Tools Challenging Yourself The Stitch

By: Danielle Quintana, PhD, MSN, RN, CNOR(E)

Published: 10/18/2023

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The first few years of becoming a perioperative nurse can certainly be overwhelming to say the least. Think about how far you have come in such a short amount of time! You have no doubt begun to develop a surgical conscience, which helps you support positive patient outcomes by incorporating knowledge of aseptic technique, infection control, and safety. It also involves ethical and moral decisions combined with an obligation to speak or act with courage to benefit the surgical patient.1 The use of surgical conscience protects patients from infection and other poor surgical outcomes and serves as a guiding principle for advocacy for surgical patients who are unable to advocate for themselves during a procedure.

Barriers

Unfortunately, sometimes there are factors that can impede us from using our surgical conscience, and we will refer to those factors as barriers. Potential barriers can include

  • the perceived hierarchy of the OR (eg, one believes a colleague from a different discipline has ultimate authority);
  • challenging personalities, such as person-related stress (eg, members of the team may not be able to control their behavior and remain civil under pressure);2 and
  • institutional culture (eg, the higher the level of perceived retaliation regarding speaking out about concerns, the lower the level of moral courage in OR nurses).3

If you have found it challenging at times to act on your surgical conscience, you are definitely not alone! Recent results of a national study of perioperative nurses4 showed that

  • 90.3% agreed that there were times that they have spoken up in the OR and faced resistance from others,
  • 46% agreed that there were barriers in the OR that prevent them from advocating to their fullest ability,
  • 40.4% agreed that there are times when they could not sufficiently use their surgical conscience to speak up due to the fear of retaliation from other members of the surgical team, and
  • 45% agreed that there were occasions when a perioperative nurse could not vocalize discovered breaks in sterile technique.

Measuring the Barriers

The Barriers to Surgical Conscience Action (BSCA) Scale was developed to measure the barriers that can impede a perioperative nurse from using their surgical conscience.5 To help you see how certain barriers may be preventing you from acting on your surgical conscience, go ahead and take the BSCA Scale now. It can also help you figure out what areas of your surgical conscience need strengthening. You should share what you learn from taking the BSCA scale with others (for example, your department educator or to those in your local or state AORN organizations). It is so important that we all make sure our surgical conscience can be used to its maximum potential!

Barriers to Surgical Conscience Action Scale

Editor's note: A shorter version of the Barriers to Surgical Conscience Action Scale is published in Quintana D, Keele R, Fredland N, Woo J. Development and validation of an instrument to measure barriers to surgical conscience action in perioperative nurses. J Nurs Meas. 2024. In Press.

References:

  1. Quintana D. Surgical conscience: a concept analysis for perioperative nurses. AORN J. 2022;116(6):533-546. doi:10.1002/aorn.13827
  2. Aholaakko, TK. Reducing surgical nurses’ aseptic practice-related stress. J Clin Nurs. 2011;20(23–24):3339–3350. doi: 10.1111/J.1365-2702.2011.03844.X
  3. Dinndorf-Hogenson GA. Moral courage in practice: Implications for patient safety. J Nurs Reg. 2015;6(2):10-16. doi: 10.1016/S2155-8256(15)30381-1
  4. Quintana D. Development and Validation of an Instrument to Measure Surgical Conscience in Operating Room Nurses [dissertation]. Denton: Texas Woman’s University; 2023.
  5. Quintana D, Keele R, Fredland N, Woo J. Development and validation of an instrument to measure barriers to surgical conscience action in perioperative nurses. J Nurs Meas. 2024. In Press.
  6. Benner PE. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. London, UK: Pearson; 2000.

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