Perioperative professional nurses' perceptions and experiences with robotic-assisted surgery
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The rapid introduction of technological innovations into health care systems creates new challenges for perioperative nurses. Especially, robotic-assisted laparoscopic surgery has changed both the physical and social context of the surgical team’s work and subsequent surgical outcomes. Despite significant changes to perioperative nursing practice, the perceptions and experiences of the professional nurses who use this technology remain unexplored. This qualitative descriptive study used interviews to examine professional nursing experiences with robotic-assisted surgeries. This qualitative descriptive research was based upon the Determinants of Innovation Within Healthcare Organizations conceptual framework. Seventeen professional perioperative nurses (preoperative, intraoperative, postoperative nurses, and nurse anesthetists) were interviewed. These encounters provided rich information about professional nurses’ perceptions of robotic-assisted surgeries. Content analysis generated three overarching themes: surgical innovation, interprofessional practice, and outcomes with each theme composed of two categories. Nurse perception and workflow emerged as the categories within surgical innovation. Professional nurse perceptions were characterized by optimistic attitudes towards robotic surgery. They appreciated the improved visualization and dexterity that the robot provided the surgeon, despite increased surgical complexity and concerns for patient safety from prolonged Trendelenburg positioning. They also reported that robotic surgery affected workflow, with intraoperative staff experiencing demanding practice changes in order to accommodate the robot. Standards and teamwork emerged as the categories within interprofessional practice. Professional nurses reported that standards in education and clinical competency requirements were needed for effective, safe robotic surgery. Teamwork during robotic surgeries necessitated different communication strategies and changes in professional nursing roles. Patient outcomes and system outcomes emerged under the overarching theme of outcomes. Nurses reported that patient outcomes of robotic surgery improved for some, but not all diagnoses, and that optimal patient outcomes were determined by the surgeon’s skill with robotic-assisted surgery. Nurses noted that some patients (e.g. those with heart and respiratory disease or glaucoma) were not candidates for robotic surgery because of the required positioning. Nurses also described various issues that affected system outcomes, such as longer time needed between surgeries. Despite describing negative aspects associated with being part of the robotic surgery team, these professional nurses were positive about this innovation and overwhelmingly committed to providing safe care to their patients.