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Background: The primary responsibility of the operating room nurse is to prevent adverse events and patient harm during surgery. Since most preventable adverse events are the result of breakdowns in communication and teamwork, or non-technical skills, training such skills should strengthen the operating room nurses' error prevention abilities. Behavioural marker systems operationalise non-technical skills; however, previous systems for operating room nurses do not cover the full extent of non-technical skills used by operating room nurses. Thus, the Non-technical Skills for Operating Room Nurses (NOTSORN) behavioural marker system was developed. Objective: The objective of this study was to establish face and content validity of the Non-Technical Skills for Operating Room Nurses behavioural marker system. This multi-item scale measures individual non-technical skills in operating room nursing. Participants: A purposive sample of operating room nursing researchers, educators, and senior clinicians from nine countries worldwide. Methods: A two round, Delphi panel with international experts in operating room nursing. The survey was administered online. Content validity index (CVI) was used to measure agreement among panel members. Results: 25 operating room nurse experts participated in the online Delphi study. After round 1, 56 items were accepted, 26 items were revised, and 1 item was dropped. Following round 2, all items (6 with minor revisions) were accepted. Thus, the Non-technical Skills for Operating Room Nurses tool comprise 81 items. The scale level CVI score for the final 81 item tool was 0.99. The individual item level CVI scores ranged from 0.9 to 1.0. Conclusions: The Non-Technical Skills of Operating Room Nurses behavioural marker system is a nuanced tool with a myriad of non-technical skills operating room nurses need to undertake their work safely. The tool's intended use includes student/trainee supervision, supervision of novice operating room nurses, self-reflection for performance reports, and in operating room nursing education. Over time, use of the tool has the potential to contribute to patient safety in the operating room. Tweetable abstract: The NOTSORN tool provides a comprehensive and holistic evaluation of OR nurses' non-technical skills for safe surgical performance.

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BACKGROUND: Operating room nurses have specialised technical and non-technical skills and are essential members of the surgical team. The profession's dependency of tacit knowledge has made their non-technical skills difficult to access for researchers, thus, creating limitations in the identification of the non-technical skills of operating room nurses. Non-technical skills are categorised in the crew resource management framework, and previously, non-technical skills of operating room nurses have been identified within the scope of the framework. The purpose of this study is to explore operating room nurses' descriptions of their practices in search for non-technical skills not included in the crew resource management framework. METHODS: This study has a qualitative design. An expert panel of experienced operating room nurses (N = 96) in Norway provided qualitative descriptions of their practice in a Delphi survey. The data were analysed in an inductive thematic analysis. This study was conducted and reported in line with Standards for Reporting Qualitative Research (SRQR). RESULTS: The inductive thematic analysis developed two themes, 'Ethical competence' and 'Professional accountability', that encompass operating room nurses' novel descriptions of their non-technical skills. The participants take pride in having the patients' best interest as their main objective even if this may threaten their position in the team. CONCLUSIONS: This study has identified novel non-technical skills that are not described in the crew resource management framework. These findings will contribute to the development of a new behavioural marker system for the non-technical skills of operating room nurses. This system will facilitate verbalisation of tacit knowledge and contribute to an increased knowledge about the operating room nursing profession.

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AIM: To identify the non-technical skills of operating room nurses. This is the first empirical study that includes scrub and circulating operating room nurses. DESIGN: A three-round modified online Delphi technique was used for this study. METHODS: Eligible participants (n = 106) with a minimum of 2 years of operating room nursing experience were selected for the expert panel by self-recruitment from a population (N = 1640) of operating room nurses. Data were collected through online surveys, based on crew recourse management theory, between April and September 2020. Descriptive statistics analysis was used for the quantitative data, and deductive thematic analysis for the qualitative data. Consensus was determined using stability between the survey rounds. RESULTS: A consensus was obtained to maintain the non-technical skills categories of situation awareness, leadership, decision-making, communication and teamwork. The qualitative data revealed several novel non-technical skills, including independent decision-making and leadership skills. CONCLUSION: The non-technical skills of operating room nurses are more extensive than previously identified. This study has contributed to a verbalization of the tacit knowledge and skills of the operating room nurses. In addition, a list of non-technical skills that should be included in the education of operating room nurses to ensure patient safety in the operating room has been prepared. IMPACT: This study addresses the lack of research on the non-technical skills of operating room nurses. When exploring the non-technical skills of scrub and circulating nurses, a diversity of novel non-technical skills was uncovered. This research will provide input for the development of a new training, supervision and assessment tool for accelerated development of the non-technical skills of operating room nurses. This contribution to the verbalization of the formerly tacit non-technical skills may facilitate clinical and formal teaching of such skills and may subsequently impact surgery-related patient safety.

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BACKGROUND: The importance of non-technical skills in the prevention of adverse events in the operating room is well documented through research. With the increased attention to non-technical skills, the need for structured training to support the development of such skills has emerged. The Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) is an instrument for structuring observation as well as rating and feedback of non-technical skills for operating room nurses, and it can be used for student supervision and self-reflection. SPLINTS-no is the Norwegian translation and adaptation of SPLINTS. OBJECTIVE: To explore the experiences of operating room nurse preceptors using SPLINTS-no in the supervision of operating room students' non-technical skills. DESIGN: An explorative qualitative design was used. METHODS: Data were collected using semi-structured qualitative interviews with 10 operating room nurse preceptors in a Norwegian university hospital. The data were analysed by inductive qualitative content analysis. RESULTS: The operating room nurse preceptors experienced that the use of SPLINTS-no had an impact on the quality of student supervision. They improved their supervision competencies, and the use of SPLINTS-no contributed to consistency in observation and supervision. There were also findings supporting that reflection over non-technical skills contributed to building an increased awareness of these skills. CONCLUSIONS: SPLINTS-no has an impact on clinical student supervision through an increased awareness on non-technical skills. It is well accepted by the operating room nurses as a supportive tool in the supervision of non-technical skills of student operating room nurses during clinical placement.

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