Term Paper on "Surgical Tech's Role in a Operating Room"

Term Paper 10 pages (3625 words) Sources: 0

[EXCERPT] . . . .

Ethnography

Defining the Scene

The cultural scene explored in this ethnography is an operating room. The individual participants in a typical operating room setting are: primary surgeon, second surgeon, surgical assistant, surgical technician, anesthesiologist, nurse anesthetist, scrub nurse, and a circulating nurse. There is also a holding room nurse and a recovery nurse not specifically inside the operating room but involved nonetheless in the surgery and recovery. The participants require highly specialized training to be able to perform their chosen roles successfully. The common goal of all of these individuals is the successful performance of an invasive medical procedure, generally for the purposes of improving or even saving a life. The patient is for the duration of the procedure the total focus of every person in that room. Years of experience and dedication devoted to those hours in which a human life is genuinely and quite literally in their hands.

Paper Plan

Throughout the course of this paper I hope to elucidate not only the specific function of the aforementioned individuals but also the value which they have ascribed to their individual roles. Through first hand observation, I have had the unique privilege not only of observing 2 surgical procedures, one of which will be used as a vignette below, but I have also had the chance to meet and interview several of the regular participants in my chosen cultural scene. This provided invaluable information in truly understanding what I was experiencing as a member of the scene. Retrospectively, I am able to look back on the experience and think about what perhaps I could h
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ave done differently as well as what factors may have influenced not only the data but the experience itself that I was not aware of at the time. Finally, I hope to reflect on this incredible learning experience, appraising the social, cultural, and psychological value of my newly acquired knowledge.

Cultural Description

The best most succinct description of my chosen scene was made by the surgical technologist I had occasion to speak with: "In the OR, we're like a single organism, all connected working towards one goal the successful completion of which is central to our continued existence." Initially I didn't understand how that could possibly be when the diverse complex roles of each participant demanded autonomy and expertise in their own right. However, observing a procedure, the analogy made perfect sense. Once in the midst of a procedure, it's as though each participant is anticipating the needs and actions of each other participant. They are prepared for the best worst and most likely scenario and act as a single minded flawless and precise unit. The most staggering aspect of this whole event though, is that these teams are not always assembled of the same people. Nurses, anesthesiologists, surgeons, they are all interchangeable depending on the procedure, the day, the time, and the relative urgency of the situation. Essentially, each individual must know their role in any procedure they may be called into so well that irrespective of who comprises the rest of the team they are able to function with the same level of confidence and expertise.

A day in the Life

A day in the life of an operating room is not terribly indicative of the social scene in which I am interested. The room, is simply a sterile room with technical equipment until it is in use. Then, as though elevated to something more than a simple space with floor walls and a ceiling, it takes on a surreal energy, alive with the hurried hushed movements that will decide a patient's longevity in this world. An operating room will see several surgical procedures on a given day. Nearly analogous to a revolving door, any operating room will hold a diversity of procedures as well as outcomes. In the quiet though between procedures, it is simply a room.

Categories Informants Use

In this setting, the categories are pre-determined and very clearly defined. Categories are organized according to job, and tenure within that field. As I had assumed, it was the Primary surgeon who was leading the carefully choreographed procedure. Conducting if you will a multipart orchestra all with vital roles in completing the procedure successfully and keeping the patient alive. The primary surgeon was responsible not only for successfully achieving his goals in the procedure but also assessing: the relative efficacy of the anesthesia, the patient's vital statistics, as well as directing the secondary surgeon, surgical assistant, surgical technologist, anesthesiologists, nurse anesthetist, and scrub nurse, determining what order to utilize chemical agents, when to retrieve sterile instruments, as well as requesting additional materials and the removal of waste materials and no longer needed instruments. With that level of control even power, comes the heavy responsibility for being largely accountable for the success of the procedure and the life of the patient. Though it was undoubtedly the primary surgeon who held the role of leader during the procedure without the careful preparation of the surgical technician and the dedication of every other person in that room, there could be no successful surgical procedures. The primary surgeon is in charge, and will ultimately be the first held to account if something goes wrong, but his actions are very nearly of equivalent value to those of the other individuals physically acting upon the patient.

How informants find Meaning

Surgeon

The surgeon I was able to interview Dr. Johansen, was initially unsure how to define the way he found "meaning" in his work. "It needs to be done I have the ability and training to do it." There had to be more though, why did he choose to train for this particular role in so draining and stressful a position. "I've always been curious, beyond curious, about how it is that a collection of cells and chemicals come together to make a person. That curiosity never abated no matter how many answers I found in school. There was no other career choice for me. I am validated for every hour of study each time I see a patient going out those hospital doors better than when they came through them. Conversely every time I encounter a patient who I know will never go through those doors under their own power after being on my table it is that much more urgent to learn and continue learning so that if I ever encounter similar problems to theirs I can make sure that the patient comes out of it alive and healthy. Knowing that I can never have an off day, that I must always strive relentlessly for perfection, it's the lazy way of making sure I get the most out of life I guess. " Modest, this Surgeon understood the full responsibility of his position yet was humble, not at all the way I had initially imagined that someone holding such power would view their position. He found meaning in his ability to affect the outcome of a patient's life while still understanding that not all things were within his ability to control. It appears that his view of being a surgeon with the experience to be primary, was integral to the way he viewed the success of his life. Not a stance to adopt lightly or with anything less than total commitment to one's chosen profession.

Anesthesiologist

The anesthesiologist is responsible for making sure that the vitals of the patient remain within healthy parameters, also that the levels of anesthetic are high enough that they are not conscious and thus unable to feel the procedure yet not high enough to cause permanent damage or even death. The anesthesiologist must have a functional knowledge of the procedure in order to anticipate the biochemical effects of each movement the surgeons make in order to always be prepared to adjust chemical levels to keep the patient from feeling pain. A difficult and demanding job, I was interested to understand why someone would choose such a specialty. I was able to interview Dr. Millen and ask him why, of all the potential careers even within medicine he had chosen to be an anesthesiologist. "Well it's quite simple really, when I was a teenager I fell off my skateboard and broke my leg quite badly. Yes, I used to skateboard, I was pretty good too. (he chuckled) Well anyway, I was hurt bad, never really grasped pain until that moment. The bones in my leg needed to be surgically set. Of course all I cared about at the time was not feeling the pain anymore. Finally the anesthetist came in and knocked me out, I have never been so grateful for a needle in my entire life. If I can give that reprieve, however briefly, to another person who is in pain or who would be in pain without me that's good enough for me." Dr. Millen understands pain, he understands how devastating and demoralizing it can be to an individual especially when they are completely helpless to effectively alleviate that pain.… READ MORE

Quoted Instructions for "Surgical Tech's Role in a Operating Room" Assignment:

Online ANP 201 ETHNOGRAPHY ASSIGNMENT

What is Ethnography?

Ethnography is a scientific method of inquiry that seeks to explain the behaviors and values that occur in a cultural scene (setting). Ethnography is also known as Participant Observation, and is the main type of research employed in anthropology. Ethnography is descriptive form of qualitative analysis.

Ethnography is not merely an objective description of people and their behavior from an observer*****s viewpoint. It is a systematic attempt to discover the knowledge a group of people have learned, and are using to organize their behavior from the participant*****s perspective. Ethnography does NOT ask what you the researcher sees the subjects doing, but what do these people see themselves doing.



How to do an Ethnography

This assignment is based on the premise that the perspective of cultural anthropology is learned through doing ethnographic field work. Ethnography is the task of describing a particular culture or setting from the perspective of the participants. It is one thing to read and study others ethnographical work, but it is a more meaningful learning experience to actually do first-hand cultural investigation. There

are 4 main stages to this assignment:

1. Acquiring Conceptual Tools ��*****" Understanding field work methods

2. Entering the Field- Gaining entry and making contact with informants

3. Doing Field Work- Gathering and recording cultural data

4. Writing up your cultural description and making sense of

data



PART I. ACQUIRING CONCEPTUAL TOOLS



This assignment is based largely on a program developed at Macalester College to get

undergraduate students involved in ethnographic research. It is summarized in the book : The Cultural Experience: Ethnography in a Complex Society (Spradley and McCurdy 2004). (On reserve at Bay College LRC)

The idea is that students learn the anthropological perspective better by

actually doing ethnographic fieldwork, rather than just memorizing concepts, or reading other ethnographic studies.

This type of assignment is different from the typical research project. Instead of doing

research in a library, you will gather information by actually doing your own fieldwork.

Learning how to do an ethnography is a complex process, which is not learned overnight. I will be assisting students on this project throughout the semester. Students are expected to submit drafts to their group for peer review, and to the instructor. The dates for the various stages of the ethnography assignment are listed on the course schedule.

STAGES OF THE ETHNOGRAPHY

Choosing a setting and getting instructor approval

Gaining Entry to setting

Observations and Field Notes

First Draft to Peer Group and Instructor

Group Review

Final Write -Up of Ethnography

The first step will be for you to get a feel for field work methodology. Read Chapter 12 on Ethics and Methods in Cultural Anthropology, and check out the book Cultural Experience on Reserve at the Bay LRC.

In order to understand field work, you need to understand what is a cultural scene.

Spradley and McCurdy define the concept of a *****"cultural scene*****" as: *****the information

shared by two or more people that defines some aspect of their experience.



1. What entails a Cultural Scene?

Cultural Scenes are closely linked to recurrent social situations. A cultural scene is the definitions of these situations held by the insider. Your job as a student of ethnography will be to determine what these definitions are, and to describe how the informants make meaning out of their participation in this cultural scene. The scene you choose to do your study on should be meaningful to you. For example, if you are studying to be a nurse or a teacher, then choose a clinical setting or a classroom for your ethnography setting.

2. Examples of Cultural Scenes:

- a radio station (knowledge of employees, knowledge of functions)

- a classroom in an elementary or secondary school (knowledge of students, or teachers)

- a local bar (knowledge of regulars, knowledge of waitresses, knowledge of bartenders)

- an athletic team (knowledge of team members, knowledge of coaches)

- a medical or social institution (knowledge of staff, knowledge of patients)

- any club or organizations (knowledge of members)

- any type of business (knowledge of workers)



II. ENTERING THE FIELD



Gaining entry into the field can be the most difficult part of conducting an ethnography. It involves getting permission to enter into a working relationship with your informants. You must win their cooperation and participation in your ethnography. This task is not simple. Asking them to talk about their perception of their experience is probably going to be new to them. Some of your questions may seem embarrassing, others trivial. Be very sure that you are not threatening your informants. Do not jeopardize their work, or ask them to reveal anything that may be seen as threatening or uncomfortable. Assure your participants that you will keep their identities anonymous. Treat your informants as your colleagues. Ask them what they would like to know about your project, and or about the cultural scene you are studying. Be willing to share your study with them, and interview them on their role at the setting. If you need a letter from me to help gain entry and /or validate your need to be in the setting, let me know and I am more than willing to do so.



III. DOING FIELD WORK

When you begin your observations you should try to go into the setting with an open mind. Try to make the familiar setting seem strange, as if you were coming from another culture where you had never seen a classroom or doctor*****s office. Every page of your field notes should be labeled with the date, time, place and should keep a time schedule for what is unfolding. (See sample field notes at end of this document)

At first you will basically keep a log of what is happening in the setting. These are Observational Notes. You will start to see hierarchies of who is in charge, and who answers to whom. You will start to ask some questions in your mind as to why certain ways of doing or behaving are taking place. You should jot down these questions in your field notes as Methodological Notes, reminding you to look for the answers in your other observations. Remember that your mission is to explain how the participants of your setting gain a sense of meaning or purpose by their being there. Depending on your setting, you might be trying to document how nurses gain meaning, or if you are focusing on the patient, then how the patient seems to feel and gain meaning from their *****patient***** encounters. If your setting is a classroom, you might focus in on the students in a class, and how they relate to one another and maybe note if there are select students your teacher would like more information on, or if there are problems in the class that could use attention. If you want, you could focus on the teacher, and what their day is like, and why they chose the profession of teaching.

No matter what setting you choose, eventually you will begin to see patterns emerge from your notes that point towards explaining the cultural scene. You begin to understand the setting from the eyes of the participants. Just the fact that you are there observing the setting, will change the way your *****informants***** respond. (People change when they know they are being observed.) You will be asked to participate as well as observe what is happening in the setting. That is why field work is referred to as *****Participant Observation.***** Your participation need not alter the setting*****s definitions or flow of events. After a while, your presence will be an accepted part of the cultural scene, but this takes time. Plan on observing in the setting on several occasions, until you feel you have a good basis to formulate your description.

One essential point: Plan on transcribing your field notes into as complete a record as possible. It is best to do this within 24 hours of your observation. While you are in the field, you will use abbreviations and maybe only jot half of what is happening till the next scene happens, and without re-copying your notes in 24 hours, this data may get lost.

Establishing Categories:

What is a Category? A category is a grouping of perspectives from your informants.

As you become familiar with your setting, you will witness different perspectives from your informants that could classify people in your setting such as *****the optimists***** or the *****pessimists*****, or *****achievers***** or *****slackers*****. The category may be a certain type of diagnosis such as those shared by chemo patients, or the *****regulars***** at a restaurant. Once you have established relationships with informants at your setting, you will begin to be able to classify their perspectives into different categories. You will want to ask questions of your informants that will help you to establish categories from your cultural scene. You will need to seek out how these categories are organized and how each category of participants derives a different sense of meaning from the setting. An informant will give you an explanation of how he or she understands the setting to be structured. This perspective may be quite different from others in a different category. Also, you will observe yourself how you think the participants gain a sense of purpose from their participation. Eventually one gets categories that emerge from the cultural scene that can be used to classify different behaviors that are exhibited in the setting. Use your field notes to create a theory as to what is going on in the setting, and how the participants gain a sense of meaning or purpose.



The next step, is to write up a vignette of a key observation from your chosen cultural scene. This vignette should demonstrate the typical behaviors found in one of your categories. This vignette describes what is going on from the participant*****s viewpoint, and it is usually in first person dialogue. When the reader reads the vignette, it is as if the person is there in the cultural scene. I will ask you to submit your vignette and your first draft of your ethnography to your group for peer review, and to me as your instructor.

(See Sample vignette below)



To get started in the field you may ask the a *****Grand Tour***** question where they will give you a tour or survey of the cultural scene. Or another way is to ask them to describe what a typical day in the life of the setting might be. You will need this in your write-up as well.

To summarize :

1. Choose a cultural scene which has significance to you and your future and get permission from your instructor to use this setting (In Writing).

2. Gain entry to the setting with permission from the persons in charge.

3. Begin by thinking about what do you wish to know about this setting, and

write questions you want to learn about. (More questions will emerge later)

4. Begin your observations by being ready to observe and participate, ready to take field notes.

5. Define the subjects and try to classify their behavior

6 Determine from your subjects those individuals that can serve as informants and seek to discover information that they use to organize their behavior.

7. Use your field notes to create a theory as to what is going on in the setting, and how the participants gain a sense of meaning or purpose.

8. Write up at least one or more vignettes that illustrates how your participants gain meaning from the setting. Be sure to keep the identities of your participants anonymous.

9. Write up your first draft and send it to your peer review group and your instructor. (Use rubric stated below)

10. Revamp and re-write your final draft

11. Submit ethnography to full discussion board for comments and responses.

12. Submit final write up to instructor and possibly to full discussion board

Some Added Suggestions:

*****The ethnographer constantly seeks to be more objective. You want your account of their behavior to be free from distortion and bias and to accurately represent what people know and believe. To be objective means to state the characteristics of objects and events as they exist, and not to interpret, evaluate, and prejudge them***** (Spradley and McCurdy 1972)

Making sense of your notes, your theories, and your observations is a difficult task-especially when you are just new at it. Be Open minded! How you organize your categories and apply meaning to the cultural scene is what is important. One helpful hint would be to color code your field notes. Certain themes emerge and you can highlight (see italicized portion of vignette)areas where similar findings bear out your theory.

So lets say you are doing your Ethnography on a church Bingo setting. You would attend several sessions and find out the process by which the participants join in the setting. You would get to know some of the participants, and ask them if they would help you understand what is happening at the setting.. The hard part here is to go into a setting and make the familiar, seem *****strange.***** After several visits you may sense that there are different reasons why persons join the setting. You might categorize these reasons and be able to describe how each type has a different agenda, or goals they obtain from their participation. You might find yourself asking lots of questions from your study, such as why does Individual #1 maintain 15 bingo cards at once. you might make an methodological note to check for individual #1*****s relationships to other players. Or you may end up getting an informant who is open and willing to share why they come and what they gain from the setting. You are trying to obtain an explanation of what the participants see themselves doing, not what you yourself see them doing.

The final step then, is to write up a vignette of a key observation from your chosen cultural scene. This vignette describes what is going on from the participant*****s viewpoint, and it is usually in first person dialog. When the reader reads the vignette, it is as if the person is there in the cultural scene.

The vignette has 3 parts:

1. An introductory paragraph telling the reader what is going

to be found in the vignette.

2. The vignette itself

3. An explanation of what was found in the vignette and why it

was significant.

A Sample Vignette:

THE WEEKLY READER

The scene is a kindergarten classroom in an urban setting, where Raymond shows he knows much more *****street smarts***** than the teacher Mrs. Smith gives him credit for.

Mrs. Smith begins the day*****s work by discussing the Weekly Reader called *****Zip*****. *****and do you know who we are going to read today? asks Mrs. Smith. *****What is his name?***** *****They begin with the initials J.B.***** *****JELLY BEAN!***** the class shouts. *****The name of this worksheet is Jelly Bean Jamboree***** *****Can you say this asks Mrs. Smith?*****

I am focusing on Raymond intensely; he is watching Mrs. Smith and is following the discussion attentively. Raymond lips the words *****Jelly Bean Jamboree***** to himself while the other kids say it or think it aloud. Raymond is a target student by the researcher because of comments from Mrs. Smith that she would like more information on him, as he is a potential retainee. His gross motor skills have been poor, he has not been able to write his name correctly or color and stay within the lines. He is slower than other students in the classroom. Raymond has tried to answer several questions but has not succeeded in saying the right answer. Mrs. Smith explains to the kids that this Weekly Reader can come to the student*****s house during the summer, if their mothers say it is okay. The students are asked to take home to their mothers a subscription notice, and maybe their mothers will let Zip visit them at hoe this summer. Raymond asks, *****How much does it cost?***** Mrs. Smith takes a second look at Raymond and replies somewhat hesitantly, ***** Three dollars*****.

Raymond may not at all times be able to get the correct answer, but he has realized from Mrs. Smith*****s language that when she says mother has to decide whether Zip can visit you at home*****, what it really means is that it depends on whether or not mother is willing to pay for the subscription. Raymond was the only one to verbalize this assumption.

Mrs. Smith continues to quiz the students on the picture on the cover of the Weekly Reader. *****What starts with the letter *****˜T***** in this picture?***** Raymond raises his hand and gets called on my Mrs. Smith. *****Beaver***** he says. Mrs. Smith asks Raymond, *****What letter does Beaver start with? Raymond shakes his head *****no.***** Mrs. Smith points to a tennis racquet and asks, *****What is this object?***** *****Tennis racquet***** the kids shout. Then Mrs. Smith points to the shoe on Zip*****s foot and asks the students to tell her what about this object starts with the letter *****T*****. Raymond starts to shout: *****Socks!! Foot!!***** but doesn*****t get the right answer. Mrs. Smith has to tell them she wants to hear *****tennis shoe*****. Next, Mrs. Smith points to the piece of luggage Zip is carrying. *****What about this starts with a letter *****˜T*****?***** Nobody guesses the right word, which is *****tag*****. What does Zip do to his shoes?***** *****What begins with a *****˜T*****?***** *****Tie***** they answer after a few wrong guesses. Raymond has answered correctly on this question.

During the question and answer period before Mrs. Smith lets them color and circle the objects which start with a *****T*****, I have noticed that Raymond keeps raising his hand to answer the questions asked by Mrs. Smith. Mrs. Smith calls on him, he doesn*****t know the answer, yet he keeps raising his hand: he doesn*****t take it down, even when he is called on. Raymond has shown that he does not understand that when hi has an answer to the question being asked, that is when he must raise his hand to get called on. When he gets the *****floor***** he no longer needs to raise his hand. Raymond behaves like he is very anxious to get the floor and to succeed by answering the questions correctly. Even when he does not know what is being asked of him, he still raises his hand, to be called on. Raymond has not learned to know when it is appropriate (in the teacher*****s perspective to raise his hand, and to subsequently get the floor, and to be prepared with an answer to the question.

********************************************

As could be seen from the vignette, Raymond demonstrated that he doesn*****t understand the appropriate roles or format of question and answer time. Repeatedly, Raymond raises his hand to answer the teacher*****s question, and when he gets called on, he doesn*****t have the right answer, yet he does not take down his hand. Learning how to go to school is one of the main issues evident throughout the Urbandale Health Education Program. The kindergarten students must first learn how to go to school with all of its rules and cues, before the student can be successful in any subject content.

Although Raymond has difficulty being successful during question and answer time, he shows conceptual superiority over his peers by understanding that when the teacher says *****if your mother says its okay, Zip can visit you at home this summer*****. What she really means is if your mother is willing to pay for a subscription. Raymond understands this implicit meaning, and demonstrates by asking Mrs. Smith *****How much does it cost?***** Raymond shows that he understands that money is involved in a subscription, and that Zip doesn*****t just appear if mother says it*****s okay: she must pay for it.

FINAL WRITE UP OF ETHNOGRAPHY

The draft and final paper you will turn in to me is due the date listed on your course schedule!

USE THE FOLLOWING OUTLINE AS TO HOW TO WRITE UP YOUR ETHNOGRAPY: (See scoring rubric below)

I. Introduction

1. Define your Cultural Scene

2. What is the plan of this paper?

II. The Cultural Description

1. A Day in the Life of your setting

2. The major Categories Informants Use

3. How are these Categories organized

4. How does your informants find meaning in their setting?

5. Vignette of a Key Observation

.

III. Fieldwork Methods

1. Why did you select this cultural scene

2. Gaining entry ��*****"problems and procedures

3. Types of fieldwork methods used. (i.e. interviews, observations, etc.)

4. What things influenced the selection of your data?

IV. Conclusion

1. What have you learned about your cultural scene?

2. What would you have done differently.

RUBRIC FOR ETHNOGRAPHY GRADE SHEET 150 POINTS

Name

Ethnography Score 150 POINTS

Your Score

1. A day in the Life of your setting ____20

2. The Major Categories Informants Use ____10

3. How are these Categories Organized ____10

4. Informants find Meaning in Setting ____20

5. Vignette of Key Observation ____20

6. Why did you select this cultural

scene? ____5

7. Gaining entry procedures ____5

8. Types of field work methods used ____5

9. Influences on Data selection ____5

10. What have you learned ____10

11. What would you have done

differently? ____ 5

12. Draft of Ethnography ____ 20

13. Discussion Board & Response ____15

TOTAL 150

COMMENTS:

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