Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.

Within the growing literature on team leadership, there is a lack of understanding which leadership process may be most reflective of intratsk leadership. In study 1, I explored leadership behaviors throughout the operating team's OR tasks and if a shared leadership approach is related to psycho-social attitudes and performance of the team. I also investigate surgical teams' engagement in safety related behaviors and if these are related to the team's workflow disruptions. As an exemplar environment, I chose to observe these dynamics in the operating theater, which is a high-stakes environment that necessitates the team to use both technical and non-technical skills. In study 2, I investigate whether a brief targeted leadership coaching sessions with residents in a simulated environment results in different (increase or decrease) leadership behaviors at an interval of 6 months. Multiple hypothesized models were tested in Study 1. The results of model 1 show that psychological safety and team trust are significantly correlated to each other (r=.704, p= <.001). The results show that psychological safety (β= -.505 p=.049) is related to performance (time of patient on bypass), while team trust (β= .177 p=.303) does not predict performance. The results of model 2 show that more extensive shared leadership behaviors are not significantly correlated with psychological safety (r=.087 p=.250) and performance (r=-.085, p =.295); however, the results show that there is a significant correlation with shared leadership and team trust (r=.260 p =.023), indicating that a more extensive shared leadership approach is related to higher team trust in a surgical team. The results of model 3 show that the length of the time-out (a safety critical behavior) does not mediate the relationship between perceptions of the usefulness of the time-out and frequency with which the circulating nurse leaves the operating room (OR). However, there is a strong relationship between the perceptions of the time-out and the number of times the circulating nurse leaves the OR (β = -.425, p<.001), indicating that for every unit increase in the perceptions of the usefulness of the time-out, the nurse leaves the OR .45 fewer times. In study 2, a paired sample t-test was conducted to understand if leadership behaviors post-coaching session are more frequent than pre-coaching session. The results show that there is no significant difference in the frequency of leadership behaviors at time 1 (M =.113, SD=.040) and the leadership behaviors at time 2 (M= .127, SD= .041); t (6)= -1.216, p = .270. / Doctor of Philosophy / Within the growing literature on team leadership, there is a lack of understanding which leadership process may be most reflective of intratsk leadership. In study 1, I explored leadership behaviors throughout the operating team's OR tasks and if a shared leadership approach is related to psycho-social attitudes and performance of the team. I also investigate surgical teams' engagement in safety related behaviors and if these are related to the team's workflow disruptions. As an exemplar environment, I chose to observe these dynamics in the operating theater, which is a high-stakes environment that necessitates the team to use both technical and non-technical skills. In study 2, I investigate whether a brief targeted leadership coaching sessions with residents in a simulated environment results in different (increase or decrease) leadership behaviors at an interval of 6 months. Multiple hypothesized models were tested in Study 1. The results of model 1 show that psychological safety and team trust are significantly correlated to each other. The results show that psychological safety is related to performance (time of patient on bypass), while team trust does not predict performance. The results of model 2 show that more extensive shared leadership behaviors are not significantly correlated with psychological safety and performance; however, the results show that there is a significant correlation with shared leadership and team trust, indicating that a more extensive shared leadership approach is related to higher team trust in a surgical team. The results of model 3 show that the length of the time-out (a safety critical behavior) does not mediate the relationship between perceptions of the usefulness of the time-out and frequency with which the circulating nurse leaves the operating room (OR). However, there is a strong relationship between the perceptions of the usefulness of the time-out and the number of times the circulating nurse leaves the OR, indicating that for every unit increase in the perceptions of the usefulness of the time-out, the nurse leaves the OR .45 fewer times. In study 2, a paired sample t-test was conducted to understand if leadership behaviors post-coaching session are more frequent than pre-coaching session. The results show that there is no significant difference in the frequency of leadership behaviors at time 1 and the leadership behaviors at time 2.

Indiana University-Purdue University Indianapolis (IUPUI) / Intraoperative adverse events (IAEs) due to interprofessional miscommunication continue to occur despite implementation of surgical checklists and focused communication trainings. Much of the previous intraoperative communication research has focused on the content and quantity of interprofessional communication instead of its context and quality, and current communication interventions seem to have varying levels of engagement, effectiveness, and persistence. The purpose of this dissertation study was to explore the psychosocial processes involved during the establishment and maintenance of interprofessional communication surrounding IAEs or potential IAEs in the intraoperative environment and to identify the perceived facilitators and barriers to communication. Twenty surgical team members participated in semi-structured interviews and described their experiences with interprofessional communication during IAEs. Grounded theory methodology was used to identify the central process, Testing the Water, and two subprocesses, Reading the Room and Navigating Hierarchy. Testing the Water describes the situational nature of interprofessional communication as surgical team members navigate factors influencing the context and probable trajectories of surgical cases and the perceptions of professional rights and responsibilities within surgical teams. Participants in this study experienced Testing the Water differently based on their professional roles and tenure; findings were organized around three emerging groups identified as inexperienced nurses, experienced nurses, and surgeons. Interprofessional communication surrounding IAEs occurred for study participants in fluid, iterative phases identified as 1) Recognition, 2) Reconnaissance, 3) Rallying, 4) Reaction, and 5) Resolution. Participants recognized IAEs or potential IAEs, gathered information through reconnaissance, rallied other team members, reacted to stabilize patients, and resolved IAEs through individual or surgical team reflection. Study participants reported using strategies during communication to accomplish two psychosocial goals, preserving the flow of surgical cases, and protecting the ‘face’ of themselves and other surgical team members. Supporting these psychosocial goals through increased psychological safety for all surgical team members potentially leads to more effective, timely surgical team communication. More effective interprofessional communication facilitates the improved situational awareness, collective sensemaking, and integrated team mental models that are critical to coordinated responses to IAEs. The findings of this study suggest practical implications to increase the effectiveness of interprofessional communication in the intraoperative environment.