Examining the Impact of the Built Environment on the OR Team

A team of nurse researchers at Cleveland Clinic Marymount Hospital conducted a phenomenological study to ascertain the perceptions of the built environment, defined as human-made surroundings intentionally designed to provide a soothing setting.

The aim of the study was to describe the lived experience of operating room (OR) personnel working in an OR equipped with SignatureSuiteTM (STERIS), an OR integration system that incorporates a relaxing, multimedia experience including scenes on a monitor, music and lighting. This was a substudy of an earlier quantitative study on the effect of the SignatureSuite environment on patients undergoing thyroid surgery.

“In the initial study, we did not find a significant change in patient anxiety based on receiving care in the SignatureSuite or in standard OR settings; however, in conversations with staff, we learned that surgical staff who worked in the SignatureSuite environment perceived lower levels of patient anxiety and an increase in their own focus on patients that needed further exploration,” says Linda Soos, BSN, RN, CNOR, a perioperative clinical nurse at Marymount Hospital. “That prompted the qualitative study.”

Soos was a co-investigator on the qualitative study, which was led by Charika Burns, MSN, RN, CNOR, perioperative nurse educator at Marymount Hospital. Co-investigators included Christian Burchill, PhD, MSN, RN, CEN, former nurse scientist II at Cleveland Clinic and research mentor for the project; MaryBeth Houlahan, BSN, RN, CNOR, nurse manager of the perioperative department at Marymount Hospital; and Rosemary Field, MS, APRN, AOCNS, a clinical nurse specialist at Cleveland Clinic.

How the research was conducted

The research team used a semistructured script with open-ended questions to conduct interviews with members of surgical teams that had used SignatureSuite at least twice within the past year. There were 23 participants, including surgeons, anesthesiologists, nurse anesthetists, registered nurses and surgical technicians.

After thorough analysis of verbatim transcripts and research team discussions, researchers identified a primary theme that encapsulated the thoughts of multiple participants. Specifically, the SignatureSuite environment calmed surgical staff, and participants perceived the environment had a calming effect on patients. In addition, participants indicated it contributed to a greater focus on the patient. “When the SignatureSuite was used, it acted as a trigger for staff to become more patient focused — to concentrate on what they were doing at the time and to perform the necessary tasks without distractions,” says Soos.

The study could have implications for hospital administrators when designing new facilities or redesigning ORs. Further research should be conducted using SignatureSuite at sites with different characteristics than the midsize community site where this study was done. New knowledge is needed on thyroid surgery populations and surgical staff caring for different populations. “Based on lessons learned from the first and second studies, it will be important to obtain new knowledge regarding how a technology aimed at creating a relaxing, multimedia experience affects patients and healthcare professionals in multiple healthcare environments,” says Field.