Development and validation of an instrument to measure surgical conscience in operating room nurses

Surgical conscience is a fundamental principle in the operating room that is well-known to perioperative nurses, yet it was a rarely studied phenomenon prior to this research. Nurses use their surgical conscience to protect patients from poor surgical outcomes. This serves as an additional layer of advocacy for patients who are unable to speak for themselves during the operative procedure. Surgical conscience begins with the knowledge of principles of aseptic technique, infection control and safety, involves ethical and moral decisions, and ultimately requires an obligation to speak or act. When a perioperative nurse fails to use their surgical conscience, the results can be costly and even worse, deadly. Thus, it is critical to be able to measure this phenomenon to develop initiatives for education and training targeted to improve nurses' surgical conscience and ultimately prevent surgical errors. However, no published quantitative measures of surgical conscience were found in the literature prior to this research. The purpose of this methodological study was to psychometrically validate a new instrument entitled the Surgical Conscience Scale with perioperative nurses. The scale was designed after review of literature, creation of a concept analysis, two rounds of content validity and pilot testing. Validity was explored by an exploratory and confirmatory factor analysis with separate groups of participants. Exploratory factor analysis results explained 55% of the variance with 3 factors: Foundational Components, Barriers to Surgical Conscience Action, and Required Attributes. The confirmatory analysis findings did not support goodness-of-fit indices in total; however, a valid and reliable subscale was discovered that measures barriers to using one’s surgical conscience. This 6-item scale, now referred to as the Barriers to Surgical Conscience Action Scale, had all six items of the factor (.734, .754, .806, .689, .573) with strong loadings (> .5). Additionally, the reliability coefficient of the subscale (α = .874) supported the recommendation to use this subscale on its own to measure barriers of surgical conscience. Use of the Barriers to Surgical Conscience Action Scale can promote awareness about the harmful consequences of failed action on behalf of perioperative nurses and help promote proficient surgical conscience usage.