Surgical First Assistant E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 274

Veröffentlichungsjahr: 2024

Beschreibung

A critical examination of an increasingly vital role in surgical practice

Surgical first assistants (SFAs) are registered nurses or operating department practitioners (ODPs) who play a crucial role in the operating theatre during surgical procedures. Under the direct supervision of the operating surgeon, an SFA provides continuous skilled assistance, performing a range of established responsibilities to assist the surgeon predominantly in the intraoperative phase of the patient’s journey, but also in the pre- and post-operative phases. The role affords theatre nurses and ODPs the opportunity to expand their clinical responsibilities and provide assistance for patients undergoing surgery by undertaking post-qualifying education. More recently, an understanding of the knowledge and skills of the SFA role has been embedded into the undergraduate curricula for ODPs.

Surgical First Assistant: The Essentials of Practice provides a comprehensive and critical examination of the knowledge, skills and behaviours that are required by SFAs to ensure patient safety and quality care. Beginning with a historical overview of the SFA role, it proceeds to outline the legal, ethical and professional aspects of the role which allows the practitioner to critically reflect on SFA practice. It also offers an in-depth analysis of the SFA’s responsibilities as defined by the Perioperative Care Collaborative through each phase of the patient’s perioperative journey from pre-operative assessment to post-operative pain management.

Surgical First Assistant readers will also find:

• A text aligned with UK national standards and best practice
• Detailed discussion of topics including pre-operative preparation with the operating theatre, assisting with haemostasis, and many more
• An approach which explores both the technical and non-technical skills required by the SFA

Surgical First Assistant is ideal for registered nurses, ODPs, student and apprentice operating department practitioners.

Leseprobe

Table of Contents

Cover

Table of Contents

Title Page

Copyright Page

List of Contributors

Foreword

Preface

Acknowledgements

Part I: Essential Concepts of Surgical First Assistant Practice

Chapter 1: The Historical Context of the Surgical First Assistant

The Role of the Non‐Medical Surgical Assistant During Conflict

Certification

National Accreditation

National Association of Assistants in Surgical Practice

Call for Clarity Over Names

A National SFA Toolkit

Accredited University Courses

The Responsibilities of the SFA

References

Chapter 2: Ethical, Legal and Professional Considerations of the SFA Role

Autonomy

Beneficence

Nonmaleficence

Justice

Case Studies

References

Part II: The Perioperative Role of the SFA

Chapter 3: Preoperative Assessment

Preoperative Assessment

Patient Education

Venous Thromboembolism Risk Assessment

Tissue Viability

Patient Mobility

Ward Preparation – Patient Fasting

Surgical Site Marking

Decision‐Making and Informed Consent

References

Chapter 4: Pre‐operative Preparation of the Patient Within the Operating Theatre

Introduction

Team Brief

Timeout

Patient Positioning

Skin Preparation

Draping the Patient

Conclusion

References

Chapter 5: Assisting with Surgical Incisions and Wound Closure

Surgical Incisions

Wound Closure

References

Chapter 6: Assisting with Haemostasis During Surgery

Introduction

Pressure

Suction and Visual Access

Sutures

Clips and Ties (Arterial Clamps)

Single Use Clips

Surgical Stapling Devices

Diathermy

Ultrasonic Devices

Laparoscopic and Haemostasis

Pharmacological Methods and Haemostatic Agents

Conclusion

References

Chapter 7: Tissue Handling and Retraction

Introduction

Tissue Viability Assessment

Tissue Types

The Responsibilities of the SFA

Handling of Tissue

Types of Retractor

Implications of Tissue Handling and Retraction

References

Chapter 8: Instrument Handling for the Surgical First Assistant

Introduction

The Use of Handheld Retractors

Retracting Away from Oneself

Retracting Towards Oneself

Tissue Forceps

Skin Hooks

Handling Artery Forceps

Suture Scissors

Minimal Access Surgery

Other Instruments Requiring Consideration

The Practitioner with Extended Skills

Toothed Dissecting Forceps

Needle Holders

References

Chapter 9: Wound Management

Introduction

Acute and Chronic Wounds

Wound Healing

Wound Care

Patient Education

Wound Assessment

Dressings

Conclusion

References

Chapter 10: Pain Management

Introduction

Analgesic Medicines

Conclusion

References

Part III: Human Factors and Non-Technical Skills

Chapter 11: Human Factors

Introduction

Implications of Human Factors

Patient Safety in Surgery

Human Error

Patient Safety Incident Response Framework

SFA’s Well‐Being

Conclusion

References

Chapter 12: Non‐technical Skills

Introduction

Classification of Non‐Technical Skills

Situation Awareness

Managing Stress and Fatigue

References

Index

End User License Agreement

List of Tables

Chapter 1

TABLE 1.1 Extended skills set of the SFA (Adapted from PCC 2018).

TABLE 1.2 List of PCC members (Adapted from PCC, 2018).

TABLE 1.3 Responsibilities undertaken by the SFA (Adapted from PCC, 2018)....

Chapter 3

TABLE 3.1 ASA classification simplified ASA (2020).

TABLE 3.2 Diagnostic screening.

TABLE 3.3 Common preoperative comorbidities, presurgery considerations and ...

TABLE 3.4 Contributing factors associated with VTE.

Chapter 4

TABLE 4.1 Information discussed in the team Brief for each patient (Adapted...

Chapter 10

TABLE 10.1 Characteristics of nociceptive and neuropathic pain.

TABLE 10.2 Characteristic of opioid receptors.

TABLE 10.3 Characteristics of local anaesthetics.

Chapter 11

TABLE 11.1 HFE Domains for the SFA (Adapted from IEHFA, 2000)

Chapter 12

TABLE 12.1 PACE acronym to assist with speaking up (Adapted from Weller and...

List of Illustrations

Chapter 1

FIGURE 1.1 The three levels of surgical assistance as clarified by the PCC (...

Chapter 5

FIGURE 5.1 ‘The NatSSIPs Eight’ Author: Nigel Roberts, Head Theatre Practiti...

FIGURE 5.2 Langer's lines in female and in male bodies. Image attribution: G...

FIGURE 5.3 Overview of incisions of the neck, chest, and abdomen: (a) Caroti...

FIGURE 5.4 Phases of wound healing. Figure attribution: Mikael Häggström, Pu...

Chapter 6

FIGURE 6.1 The structure of blood vessels.

FIGURE 6.2 Use of vascular clips and ties for haemostasis.

FIGURE 6.3 Application of forceps by Assistant for application of diathermy....

Chapter 8

FIGURE 8.1 Retracting away from the assistant.

FIGURE 8.2 Opening an artery forceps with the right hand.

FIGURE 8.3 Handling of artery forceps with the left hand.

FIGURE 8.4 Suture scissors being held in the right hand.

FIGURE 8.5 Suture scissors being ‘palmed’.

FIGURE 8.6 Toothed dissecting forceps held in a pencil grip.

Chapter 10

FIGURE 10.1 Physiology of pain and analgesia sites of action.

FIGURE 10.2 11‐point numerical rating scale for pain.

FIGURE 10.3 Reverse pain ladder for managing acute pain.

Chapter 11

FIGURE 11.1 HFE considerations that may affect the SFA.

FIGURE 11.2 SHEEP model acronym.

CHART 11.1 Number of incidents reported by in England Between Oct 2003 and J...

FIGURE 11.3 The Dirty Dozen

FIGURE 11.4 Identification of what could affect SFA performance.

Guide

Cover Page

Table of Contents

Title Page

Copyright Page

List of Contributors

Foreword

Preface

Acknowledgements

Begin Reading

Index

WILEY END USER LICENSE AGREEMENT

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Surgical First Assistant

The Essentials of Practice

Edited by

Julie Quick

Birmingham City University

Birmingham, UK

Mark Owen

University of Gloucestershire

Cheltenham, UK

This edition first published 2025© 2025 John Wiley & Sons Ltd

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Library of Congress Cataloging‐in‐Publication Data Applied For:Paperback ISBN: 9781394210824

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List of Contributors

Jenny AbrahamUniversity Hospitals Coventry and Warwickshire NHS TrustSenior Teaching FellowCoventry UniversityCoventryUK

University of SunderlandSunderlandUK

Coventry UniversityCoventryUK

Ally AckbarallyDe Montfort UniversityLeicesterUK

SFA and Human Factors Institute of HealthHealth Policy and Social CareResearch, De Montfort UniversityLeicesterUK

Nisha BhudiaRoyal Brompton & Harefield Hospitals, part of Guy's & St Thomas' NHS Foundation TrustLondonUK

Carolina BrittonUniversity College London HospitalsLondonUK

Association for Perioperative PracticeHarrogateUK

Felicia CoxRoyal Brompton & Harefield Hospitals, part of Guy's & St Thomas' NHS Foundation TrustLondonUK

Susan HallAnglia Ruskin UniversityChelmsfordUK

Dave LawsonProgramme leadSenior LecturerEdgehill UniversityUK

Georgina LewisSurgical Care Practitioner at Gloucestershire Hospitals NHS Foundation Trust (GHNHST) and Casual Lecturer at Birmingham City University (BCU)BirminghamUK

Mandy ManghamRegistered Nurse Surgical Care PractitionerThe Royal Wolverhampton NHS TrustHCA Healthcare, UKAssociate Member of the Royal College of Surgeons of England Affiliate member of the Faculty of Perioperative Care with the RoyalCollege of Surgeons of Edinburgh Casual Lecturer at Birmingham City UniversityCommittee Member of the Association of Surgical Care Practitioners

Mark OwenUniversity of Gloucestershire CheltenhamUK

Julie QuickBirmingham City UniversityBirminghamUK

Lee RollasonBirmingham City UniversityBirminghamUK

Mark RobertshawManor Hospital BedfordBedfordUK

Foreword

The surgical first assistant (SFA) role has been around for more than a decade but despite this, many students, healthcare professionals and educators remain unclear about the role and their responsibilities. There are multiple reasons for this, for example: (i) staff shortages have resulted in limited access to training, (ii) financial constraints result in limited opportunities and (iii) rigid attitudes toward existing boundaries and scopes of practice have slowed the adoption and utilisation of the role in many regions. Nevertheless, the situation is beginning to change, and there is now greater awareness of the SFA role and how they can positively contribute to the perioperative setting. These benefits are not limited to an individual developing their skills but include increased organisational efficiency and improved patient experience.

Until now, a comprehensive resource that can bring clarity to those unclear about the SFA role, those interested in undertaking training, and the educators responsible for teaching the relevant knowledge and skills has not been available. Fortunately for us, this void has now been filled by Julie Quick and Mark Owen who have created the definitive resource that comprehensively explains the SFA role through contributions from a range of experts. Both authors have been instrumental over the years in shaping the perioperative nursing and ODP professions through their academic and professional body contributions. Surgical First Assistant: The Essentials of Practice is a timely, important, and well‐written book and one further example of their continued contributions to their professions and perioperative care. I would expect this textbook to be the go‐to resource for those interested in the SFA role for the foreseeable future.

Daniel Rodger,

Senior Lecturer in Operating Department Practice,

London South Bank University

Preface

It is a privilege and pleasure to introduce you to this book, which is the first to exclusively explore the roles and responsibilities of the surgical first assistant. Defined as an extended member of the surgical team by the Royal College of Surgeons of England, the surgical first assistant (SFA) has become widely accepted within the NHS and Independent Healthcare Sector to enhance patient care.

Each chapter is written by contributors who have experience as a surgical assistant in clinical practice and/or are experts in their field. Many have also taught non‐medical surgical assistants in higher education. Their contributions reflect their passion for teaching and dedication to improving patient outcomes through skilled surgical assistance.

The book provides you with an up to date and comprehensive overview of the roles and responsibilities, and skills required for the SFA. It is divided into three parts: Part one provides you with an historical overview of the SFA role in the United Kingdom. A case study approach is then utilised to review some of the legal, ethical and professional considerations of the SFA role, providing you with opportunities for critical reflection.

Part two explores the responsibilities of the SFA role as defined by the Perioperative Care Collaborate: SFA Statement (PCC, 2018). Each chapter moves through each phase of the patient’s perioperative journey from preoperative assessment, assisting during surgery to wound care and postoperative pain management.

Part three explores human factors and non‐technical skills of the SFA as an extended member of the surgical team helping you to demonstrate the behaviours that will allow you to promote safe and effective care.

Whether you are a registered nurse or ODP undertaking a post‐registration SFA module or an ODP student or apprentice studying an undergraduate course, we hope this book will be a trusted companion in your professional development.

Julie Quick and Mark Owen

Acknowledgements

Writing this book has been a privileged journey and it would not have been possible without the support and guidance of many individuals. Firstly, our thanks go to the publishing team at Wiley who have supported us from our initial concept through to the production and publication of the book you are now reading. Our ambition to write this Surgical First Assistant (SFA) book, which had been in draft format for several years, would not have been possible without Wiley's confidence in the importance of such a key text.

While our names are on the cover, as editors we are indebted to all our colleagues who contributed to each chapter. Your expertise will be an inspiration to current and future SFAs through the development of the required knowledge, skills and understanding that will enhance the quality of care provided to surgical patients.

To our SFA students, past and present, your experiences and feedback on providing surgical assistance have helped shape this book and enriched its content to provide an invaluable resource for students and practitioners providing assistance as part of the extended surgical team.

We are both indebted to our dear family and friends during this writing journey. It would not have been possible without your inspiration and support, and this book is dedicated to each one of you.

Finally, to you the reader, thank you for choosing to read it. Whether you are an established surgical first assistant, or developing your skills as registered practitioner or student, we hope this book provides you with opportunities for critical reflection to help you provide the best standard of care for your patients.

Sincerely yours,

Julie Quick and Mark Owen

PART IESSENTIAL CONCEPTS OF SURGICAL FIRST ASSISTANT PRACTICE

CHAPTER 1The Historical Context of the Surgical First Assistant

Julie Quick1 and Mark Owen2

1 Birmingham City University, Birmingham, UK

2 University of Gloucestershire, Cheltenham, UK

As a non‐medical surgical assistant, the surgical first assistant (SFA) is an established role in many NHS Trusts and independent sector health organisations in the United Kingdom (UK). It is a role undertaken by registered practitioners who work as part of the extended surgical team, performing a range of established responsibilities to assist the surgeon, predominantly, in the intra‐operative phase of the patient’s journey but also in the pre‐ and post‐operative phases. Traditionally, the role afforded theatre nurses and operating department practitioners (ODPs) the opportunity to expand their clinical responsibilities and provide assistance for patients undergoing surgery by undertaking post‐qualifying education. More recently, an understanding of the knowledge and skills of the SFA role has been embedded into the undergraduate curricula for ODPs.

This chapter identifies the historical development of the SFA role from both clinical and academic viewpoints and affirms the SFA’s expert position as a wider member of the extended surgical team today. It briefly identifies the current responsibilities of the SFA that are further explored in subsequent chapters of the book.

THE ROLE OF THE NON‐MEDICAL SURGICAL ASSISTANT DURING CONFLICT

While the title ‘Surgical First Assistant’ has been in use since 2012, the role of the non‐medical surgical assistant is not a new concept and has been active within healthcare in the United Kingdom and overseas for many centuries in one role or another with varied titles. Rothrock (1999) identified that the non‐medical surgical assistant role has evolved significantly from the surgeons’ mates, who assisted on the battlefield and in hospitals in the 19th century. The first record of non‐medical surgical assistants was in the 19th Century when British nurses acted as surgeons’ assistants during the Crimean War. Under the direction and guidance of Florence Nightingale, they not only assisted with operations but also undertook additional skills to meet the high demand caused by the increasing number of casualties seen within hospitals at the time. Nurses were repeatedly called upon to act as surgeons’ assistants during times of conflict where, working under extreme conditions and with shortages of medical staff, the nurses perfected the role of first assistant; routinely assisting surgeons during operations but also expanding their role as required such as undertaking haemostasis and suturing (Rothrock 1999). This illustrates that non‐medical assistants were a valued addition to the surgical team and were able to develop their skills and abilities to fill the gaps caused by the shortage of medical colleagues. Following the notable success of nurses acting as first assistants in field hospitals during combat, non‐medical surgical assistant roles complete with certified training routes emerged from the 1960s onwards in the United States (Hains et al. 2017); however, unlike the early acceptance of non‐medical roles in other parts of the world, the SFA role took longer to establish in the United Kingdom.

The professional body, the College of Operating Department Practitioners (CODPs), in providing a historical overview of the development of the ODP profession, refers to several surgical assistance roles with some overlap (CODP 2021). These include ‘handlers’ who were employed by surgeons in the period prior to the development of anaesthesia to hold down patients. In the 19th century, ‘Surgerymen’ were responsible for seeing to instruments used by the surgeon, and ‘Box Carriers/Box Boys’ who were employed by the surgeon to carry boxes of instruments required by the operating surgeons. Beadles followed the surgeon and ensured cautery irons were kept heated and ready for immediate use by the operating surgeon (Pope 1962). A notable figure, Josiah Rampley, who attended approximately 40,000 operations as a surgical beadle, and whose name may appear familiar, invented the sponge holder and needle holder (CODP 2021; Pope 1962).

Lewin’s Report

Walpole Lewin’s report in 1970 on the organisation and staffing of operating departments recommended the training of a new grade of staff called operating department assistants who studied the City and Guilds 752 Hospital Operating Department Assistants training programme (CODP 2021). The City and Guilds’ training book, often referred to as the ‘blue book’, identified a number of skills including assisting with skin prep, draping of patients and identification, presentation and handling of instruments that may have been interpreted differently by different training centres and operating departments, and so some operating department assistants may have assisted the surgeon at this time.

CERTIFICATION

In the 1970s, the Department of Health and Social Security (1977) recognised the increasing contribution of nurses undertaking technical tasks that were either an extension of nursing practice or delegated by doctors. This recognition allowed registered nurses to extend their role following in‐house training, assessment and subsequent certification. The nurse acting as first assistant to the surgeon was one of these extended roles and certification for nurses continued through to the 1990s when the United Kingdom Central Council for Nurses, Midwives and Health Visitors (UKCC) became concerned that nurses were taking on additional skills erroneously under the impression that accountability was transferred to the assessor (McHale and Tingle 2007). Subsequent requirements, since replaced by the Nursing and Midwifery Council’s (NMC) Code of Conduct (2018), ensured that additional responsibilities undertaken by nurses were based upon the standards laid down in their professional frameworks. This guaranteed that nurses relied, and continue to rely, upon their clinical judgment supported by appropriate training to inform expanded practice.

NATIONAL ACCREDITATION

The implementation of national and international directives (National Health Service Management Executive 1991; Calman 1993; European Community 1993) in the early 1990s saw a number of clinical hours worked by medical staff reduce, and the time spent by surgical trainees in the clinical area condense. This led to a decline in the availability of doctors to assist routine operating lists. To overcome these shortages, theatre nurses – like nurses before them – stepped up to fill the gaps created by these directives. Taking on additional responsibilities ensured surgical services were maintained. Nurses, however, rapidly came under pressure to provide a level of assistance for which they were ill equipped. Hospitals introduced in‐house training programmes that Farrell (1999) argued were extremely varied and resulted in little or no standardisation of non‐medical surgical assistant roles. The National Association of Theatre Nurses (NATN) (now the Association for Perioperative Practice, to reflect the multidisciplinary theatre team) raised concerns over the sustainability of such practice and introduced guidelines to support nurses undertaking surgical assistant roles (NATN 1993, 1994). NATN issued additional guidance on developing non‐medically qualified roles within the perioperative environment that recommended clearly identified posts and nationally acceptable training programmes (NATN 1997). Consequently, the English National Board (ENB) for nursing, midwifery and health visiting which had the legal responsibility for nurse education, provided approval of the first nationally recognised first assistant course for nurses wishing to train as surgical assistants which were delivered by Schools of Nursing. The ENB also approved training for the Surgeon’s Assistant, the fore runner to the surgical care practitioner, a role undertaken by registered healthcare professionals who work as a member of the surgical team, but unlike the SFA, can perform some surgical interventions (RCS n.d.).

In the early 1990s, a consultation to assess the contribution of all non‐medical surgical assistants was undertaken and following positive reviews a joint working party was set up between the Royal College of Nursing (RCN) and the Royal College of Surgeons of England (RCS) to advance the concept of non‐medically qualified surgical assistants in practice. This group proposed that both nurses and allied health professionals could be safely trained to perform a variety of perioperative skills including assisting with surgery (RCS 1994). The addition of a non‐medical surgical assistant to the surgical team was considered to expedite surgery and improve patient care (DH 1999).

NATIONAL ASSOCIATION OF ASSISTANTS IN SURGICAL PRACTICE

In 2001, a voluntary professional body, the National Association of Assistants in Surgical Practice (NAASP), emerged to provide guidance and support for practitioners undertaking non‐medical surgical assistant roles or looking to implement them. NAASP published the advanced scrub practitioner (ASP) toolkit which defined the knowledge, skills and standards of the ASP role (Thatcher 2007). For the first time in the history of non‐medical surgical assistants, national accredited training programmes accessible to both registered nurses and ODPs undertaking training as a surgical assistant were rolled out by universities throughout the United Kingdom, endorsed by NAASP. The NAASP portfolio included an initial module which allowed registered practitioners to provide surgical assistance and after successful completion of this module, practitioners could then undertake the second module which saw them acquire extended surgical skills which allowed them to perform additional responsibilities detailed in Table 1.1. Both modules were run successfully until endorsement ran out when NAASP was dissolved in 2012 and amalgamated with the Association for Perioperative Practice to form part of the specialist interest group for advancing surgical roles (Clinical Surgery Journal 2012).

In 2003, the newly formed perioperative care collaborative (PCC) that represented different perioperative professional groups, published their position statement on the role of the ASP (see Table 1.2 for current PCC members). This statement advised practitioners to use the title of ASP to reflect the expert practitioner status of non‐medical surgical assistants to assist with evaluation of job profiles being undertaken as part of the Agenda for Change proposal and the NHS Lifelong Learning Strategy developed by the Department of Health (2001).

TABLE 1.1 Extended skills set of the SFA (Adapted from PCC 2018).

Suturing of skin layers

Administration of prescribed, superficial local anaesthetic

Suturing and securing wound drains

Superficial haemostasis including surgical diathermy

TABLE 1.2 List of PCC members (Adapted from PCC, 2018).

Association for Perioperative Practice

Association of Independent Healthcare organisations

British Association of Day Surgery

British Anaesthetic and Recovery Nurses Association

College of Operating Department Practitioners

Royal College of Nursing

CALL FOR CLARITY OVER NAMES

Despite NAASP and the PCC promoting the use of the ASP title from the early 2000s, several different titles used by non‐medical surgical assistants continued to be used in practice. A position statement by the Royal College of Surgeons (RCS) in 2010 recommended the public be informed about the background and meaning of job titles in use within the surgical setting (RCS 2010). The RCS then issued another position statement that recognised how crucial non‐medical surgical assistant roles had become to the delivery of some surgical services but called for clarity regarding the varied titles in use by practitioners who were assisting with surgery to prevent confusion for patients and clinicians (RCS 2011). See Quick et al. (2015) for titles that have previously been used. With NAASP dissolved, the PCC responded by issuing an updated position statement in 2012 that provided a consensus in the United Kingdom regarding the job titles appropriate for perioperative practitioners who provide three different levels of assistance (PCC 2012). Each of the three roles recognised by the PCC (2012) in Figure 1.1 can be undertaken by a registered perioperative practitioner.

FIGURE 1.1 The three levels of surgical assistance as clarified by the PCC (2012).

In an updated position statement in 2018, the PCC defines the SFA as,

… the role undertaken by the registered practitioner1who provides continuous, competent and dedicated surgical assistance to the operating surgeon throughout the surgery: Surgical First Assistants practice as part of the surgical team, under the direct supervision of the operating surgeon.

(PCC 2018)

A NATIONAL SFA TOOLKIT

Despite a clear new title as well as clear responsibilities previously set by NAASP, the number of universities who offered the accredited SFA post‐registration modules declined after 2012, most likely due to the dissolution of NAASP. Consequently, practitioners struggled to find national‐accredited courses and healthcare organisations developed their own in‐house courses for registered theatre staff. One problem with in‐house courses is that that they are not usually transferable from one employer to another, and so in response to their pledge to continue the work started by NAASP, AfPP performed an extensive update to the NAASP ASP curriculum and published the first edition of the AfPP surgical first assistant toolkit. The purpose of the toolkit was twofold: in the absence of university‐accredited courses, it primarily acted as a national training tool for practitioners by defining the knowledge and skills required by SFAs. Practitioners completed the toolkit alongside in‐house or other SFA training packages. Second, it acted as a reference source for employers to assist with the strategic planning and roll out of the SFA role in the operating theatre.

ACCREDITED UNIVERSITY COURSES

With the role of the SFA becoming widely accepted within the NHS and Independent Healthcare Sector, a number of universities once again offered post‐registration modules. The updated PCC SFA statement (PCC 2018) states that the role of the SFA should only be undertaken by someone who has successfully completed a validated university programme of study. There was also demand from employers and practitioners as registered nurses and ODPs looked to expand their skill set for personal and professional development. In a service evaluation conducted by Lowes et al. (2020), ODPs indicated that in relation to continuing professional development (CPD), surgical first assisting was a popular area for further study. It is envisaged that demand by ODPs to undertake SFA post‐registration training will eventually decline with the PCC (2018) statement recognising the College of Operating Department Practice (2018) Bachelor of Science (Hons) in ODP (Bachelor of Science in Operating Department Practitioner in Scotland) now being a validated programme of study for SFA training.

While the current Standards of Proficiency for ODPs (HCPC 2023) identifies that ODPs need to ‘understand the role of the surgical first assistant in assisting with surgical intervention’, the professional body for ODPs expect ODP learners to also ‘demonstrate proficiency in enhanced surgical skills, commensurate with a surgical first assistant’ (CODP 2018: 29).

THE RESPONSIBILITIES OF THE SFA

The PCC set out the technical and non‐technical responsibilities of the SFA in 2012 but in 2018 updated it to reflect the development of the SFA role in extended surgical teams (PCC 2018). The responsibilities of the SFA are listed in Table 1.3 this list is not a definitive list of skills required in every surgical speciality but rather general guidance on the SFA’s role which means that the SFA will need to liaise with their manager and surgical teams to identify their exact duties based on these responsibilities which should be reflected in their job description, person specification and supported by organisational policy (PCC 2018). Part two of this book examines the responsibilities of the SFA role throughout each phase of the patient’s perioperative journey.

This historical development of the SFA role has been presented from the early days of international nursing to the UK‐specific role definition of a registered practitioner who performs assistance to the operating surgeon throughout a patient’s surgery. Furthermore, the history of the ODP role development and the incorporation of SFA roles at both pre‐ and post‐registration levels have been discussed. The perspectives of professional bodies and their contribution as a collaborative have also been identified and are a useful starting point for the preceding chapters of this book.

TABLE 1.3 Responsibilities undertaken by the SFA (Adapted from PCC, 2018).

Assisting with patient positioning, including tissue viability

Skin preparation and draping prior to surgery