Concept Analysis: Wrong Site Surgery
Definition of the Concept: The operational definition following completion of the principle-based analysis: WSS is a preventable medical/nursing error that involves surgery on the wrong patient, wrong site, wrong level/part, wrong procedure, or wrong side during surgery or invasive procedure.
Concept Analysis Approach: Principle-based concept analysis was utilized to examine WSS in the context of epistemological, pragmatic, linguistic, and logical principles. The conceptual analysis from the epistemological principle is that WSS is an accepted universally defined concept. From the pragmatic principle, the role of the perioperative nurse in WSS is recognized as a critical component to ensuring patient safety and minimizing risk for WSS. However, there is limited research in the nursing domain on the concept of WSS that include, but is not limited to nursing interventions, perceptions, attitudes, and contributions to prevention of WSS. The linguistic analysis revealed WSS has consistent meaning and utilization in research. However, there are specific labels that occur within the concept of WSS that should be defined by a national authority such as the Association of periOperative Registered Nurses (AORN) or The Joint Commission to enhance clarity of the concept (i.e., wrong patient, wrong site, wrong level, wrong part, wrong procedure and wrong side). Despite this analysis, the logistic analysis supports that WSS is a broadly defined concept that does not lose meaning when applied to research with different concepts. The concept would benefit from application of theoretical frameworks to enhance conceptual clarity.
Logical Linking the Concept to Nursing Practice or Research Problem: Research in the area of WSS is primarily within the discipline of medicine. It is essential that that research must be conducted to represent the significant role of the perioperative nurse in prevention of WSS. Recently, members of the Association of periOperative Registered Nurses (AORN) identified the prevention of wrong site/procedure/patient surgery as the top patient safety priority for perioperative nursing practice. The principle-based concept analysis identified characteristics associated with the concept of WSS that include: (a) the dynamic state of WSS, (b) the challenges for determining an accurate incidence of WSS in the United States, (c) lack of a universally acceptable set of definitions for WSS research and (d) minimal research reflecting perioperative practice contributions to patient safety involving risk reduction strategies to minimize patient risk.
Conclusion: In this concept analysis, literature from medicine, nursing and psychology was reviewed and an operational definition of the concept of WSS was developed. Additional nursing research directed at factors associated with WSS that include patient, nurse, system and environmental factors are an essential step in promoting patient safety. The prevention of WSS is a multidisciplinary responsibility, in which the perioperative nurse serves an integral role. Nursing research on best practices to prevent WSS is essential to eradicate the egregious preventable patient error.