Inside Medicine: The theatre sister

Training will need to be more varied to meet needs, Kean says

In a series focusing on medical specialisms, the BBC News website meets Kean Chan, who talks about being a theatre sister at London's Royal Brompton Hospital.

A theatre, or scrub nurse, works in the hospital operating theatre, assisting the surgeons.

Kean Chan's CV

WHAT IS YOUR JOB?

My role in the theatre department is to assist surgeons during adult and paediatric heart and lung operations.

My particular speciality is managing, co-ordinating and scrubbing for adult heart surgery as well as teaching less-experienced nurses.

Scrubbing involves handing the surgeon instruments, sponges and other items during an operation, and checking that they are all back in place at the end of the procedure.

I work within the sterile field, which is the area closely surrounding the operating table and instrument tray.

Prior to surgery I scrub my hands and arms with special disinfectant soap and wear gowns, hair nets and gloves

My role also involves managing the daily operating list and co-ordinating the multi-disciplinary team in the department.

WHAT IS THE MOST COMMON CONDITION?

At the Royal Brompton, the most common condition for adult patients is coronary heart disease.

Heart attack is one of the major causes of death in developed countries.

Thickening of the heart's arteries is the major cause of a condition called ischaemic heart disease - when blood finds it difficult to reach the heart.

This condition is caused by many risk factors such as smoking, high blood pressure, high cholesterol, diabetes and family history.

WHAT IS THE MOST COMMON PROCEDURE?

The most common procedure is the coronary artery bypass graft.

Firstly, patients are x-rayed in order to examine the blood vessels or chambers of the heart, which is called coronary angiography.

Many patients can be helped by medical treatment, but some require surgery.

The procedure involves taking veins from the patient's legs and using the mammary artery, located behind the breast bone.

The leg veins and mammary artery are connected to the arteries of the heart that are beyond the blockages so that blood can be diverted around the affected areas.

The operation takes about four hours and involves a team of surgeons, anaesthetists, nurses and perfusionists - who ensure oxygen supply to the blood, even when a patient's lungs and heart are temporarily not functioning.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

As with most jobs, managing the different personalities in the team can be a challenge.

This is probably accentuated in an theatre environment as there is a level of risk involved and we see some extremely ill patients.

WHAT IS YOUR MOST SATISFYING CASE?

Completing all the work in a challenging day feels very good.

Making sure all the operations are carried out with no cancellations or delay.

Theatre nurses assist the surgeons

Making sure all the members of the multi-disciplinary team are co-ordinated and the patients' operations are successful.

It is especially satisfying to know that you have played a role in making a really big difference to a patient's wellbeing and that he or she will leave the hospital to enjoy a healthier and longer life.

WHY DID YOU CHOOSE THIS SPECIALTY?

The work is interesting and varied and there are always new techniques to learn and challenges to overcome especially when one works in the Royal Brompton as it is a world renowned cardiac centre.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

No. This role has always kept me challenged and interested. I really enjoy it.

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

Procedures that are commonplace today, such as heart bypass grafts, were once new and difficult.

Procedures that are unusual and difficult today, will become common and routine in the future - by which time we will be developing new techniques and procedures to enable us to treat even more complex cases!

To meet theatre staffing needs in the future, it is likely that staff will need to learn a wider range of skills and be able to work across disciplines in the theatre.

For instance, an ideal theatre practitioner may well need to be working with the surgeon and the anaesthetist. There will be a big role training these staff.

CV - Kean Chan

1977: Completed first level registered nurse training at Hackney Hospital, London

1982: Theatre speciality in Kings College Hospital, London

1984: Moved to Royal Brompton, London, progressing from theatre staff nurse to theatre sister

Click here to return