SELF/Perioperative Nursing/Surgical First Assistant/Psychomotor Skills Practice Instructions
The Surgical First Assistant – Perioperative Nursing (ECSACONM)
[edit | edit source]Overview
[edit | edit source]This page provides a psychomotor skills practice guide for first surgical assistance, developed for perioperative nursing training under ECSACONM (East, Central and Southern Africa College of Nursing). It is intended as a self-directed developer worksheet, outlining the sequential steps, associated learning objectives ("good skills"), common errors, and practical guidance for the role of the Surgical First Assistant.
During practice, non-sterile instruments, equipment, and supplies may be used. For this simulation, treat every instrument, supply, and surface as though it were sterile. Maintain sterile technique throughout the exercise and respond to any simulated contamination as you would during an actual surgical procedure.
This practice requires a simulated operating room environment. In addition to the learner, one participant should act as the surgeon and another as the scrub nurse/surgical assistant. Where possible, a third participant may act as the circulating nurse to support realistic communication and workflow.
Perform every action as though patient safety depends on it. Anticipate the surgeon's needs, communicate clearly, maintain safe tissue retraction, use suction and irrigation appropriately, manage sutures and sharps safely, and remain aware of both the operative field and the wider operating room environment throughout the procedure. Consistent practice under realistic conditions will develop the technical skills, teamwork, anticipation, and situational awareness required of a competent Surgical First Assistant.
Purpose
[edit | edit source]To guide nursing students and practitioners through a systematic, step-by-step process for providing first surgical assistance, ensuring patient safety, effective anticipation and communication, safe tissue handling, and continuous situational awareness throughout the procedure.
Psychomotor Skills Practice Instructions
[edit | edit source]| Step | Instructions | Good Skills (Learning Objectives) | Common Errors | Guidance | |
|---|---|---|---|---|---|
| 1 | Gather supplies (articulated) | Say aloud: "I have confirmed that the planned procedure and surgeon's preferences are understood. All required retractors, forceps, suction equipment, scissors, needle holder, gauze, sutures, lighting, and backup supplies are available, functional, and arranged in the order they will be needed before the incision begins." | |||
| 2 | Perform hand hygiene and don PPE (articulated) | Say aloud: "Before entering the sterile field, I perform surgical hand preparation and correctly don my gown, gloves, mask, eye protection, and other required personal protective equipment without contaminating any sterile surface." | |||
| 3 | Assist with initial exposure of the surgical site and suctioning | Position retractors exactly where directed by the surgeon. Apply only enough retraction to expose the operative field while protecting surrounding tissues. Use suction carefully to remove blood or fluid without contacting or damaging tissues. | Retraction is steady, exposure is maintained, suction is controlled, delicate structures are protected, and the operative field remains clearly visible without unnecessary tissue trauma. | Applying excessive retraction, allowing retractors to slip, contacting tissues aggressively with suction, or delaying response to the surgeon may cause tissue injury or obstruct visualization. | Think of exposure and tissue protection as equally important. The goal is not maximum retraction but the minimum force required for safe visualization. |
| 4 | Maintain surgical site visibility throughout | Continuously monitor the operative field. Adjust retractors, suction, and tissue exposure as the procedure progresses while responding promptly to changes requested by the surgeon. | The operative field remains consistently visible. Retraction and suction are adjusted proactively with minimal prompting. Communication remains continuous throughout the procedure. | Allowing blood or irrigation fluid to accumulate, maintaining excessive static retraction, or waiting until visibility is lost before responding interrupts surgical flow. | Watch the operation continuously rather than focusing only on your own instruments. Anticipate the next adjustment before it becomes necessary. |
| 5 | Handle and pass instruments and supplies | Pass each instrument firmly into the surgeon's hand in the correct orientation for immediate use. Present sharps safely while maintaining sterility and anticipating upcoming instrument requirements. | Instruments are delivered safely, promptly, and correctly oriented. Sterility is maintained throughout. Instrument selection consistently matches the stage of the procedure. | Passing the wrong instrument, presenting it in the wrong orientation, delaying delivery, or handling sharps unsafely disrupts workflow and increases safety risks. | Watch both the surgeon's hands and the progress of the operation. Anticipation is just as important as correct instrument handling. |
| 6 | Assist with tissue manipulation and haemostasis | Handle tissues only as directed by the surgeon. Support tissues gently, provide swabs or haemostatic materials promptly, and assist with maintaining haemostasis while minimizing tissue trauma. | Tissue handling is gentle and deliberate. Assistance is timely, haemostatic materials are anticipated, and tissue integrity is maintained throughout the procedure. | Applying unnecessary force, manipulating tissues without instruction, delaying haemostatic support, or creating unnecessary movement may increase bleeding or tissue injury. | Every tissue movement should have a purpose. Use the minimum force necessary while remaining responsive to the surgeon's directions. |
| 7 | Apply appropriate retraction force | Apply only enough retraction to expose the operative field. Continuously adjust pressure as tissues move and avoid prolonged compression of nerves, vessels, muscles, or skin. | Retraction provides adequate exposure without excessive tissue tension. Tissue colour, perfusion, and integrity remain preserved throughout the procedure. | Excessive force, prolonged static retraction, tissue blanching, overstretching, or ignoring signs of tissue stress may result in ischemia or nerve injury. | Good exposure comes from proper placement rather than excessive pulling. Frequently reassess tissue response during every stage of the procedure. |
| 8 | Pad and protect pressure points | Place sterile gauze or protective padding between retractors and vulnerable tissues whenever prolonged retraction is required. Reassess padding throughout the procedure. | Vulnerable structures remain protected, padding remains correctly positioned, and prolonged pressure on nerves or vessels is avoided. | Omitting protective padding, allowing padding to shift, or continuing prolonged pressure despite tissue blanching increases the risk of pressure injury. | Every time retraction continues for an extended period, reassess whether additional protection is needed. |
| 9 | Angle retractors along tissue planes | Position retractors parallel to natural tissue planes while maintaining stable exposure. Adjust the angle whenever tissue orientation changes during the procedure. | Retractors follow natural anatomical planes, remain stable, and provide effective exposure with minimal tissue distortion. | Positioning retractors across tissue planes, creating unstable retraction, or generating unnecessary tissue tension may compromise visualization and increase tissue trauma. | Let normal anatomy guide retractor placement rather than forcing tissues into unnatural positions. |
| 10 | Adjust retractors frequently | Periodically release and reposition retractors while maintaining adequate exposure throughout prolonged procedures. | Retraction pressure is redistributed regularly, tissue compression is minimized, and surgical exposure remains uninterrupted. | Maintaining prolonged static retraction or failing to reassess tissue condition may contribute to tissue ischemia or nerve compression. | Small adjustments made regularly are safer than large corrections made too late. |
| 11 | Monitor the operative field and anticipate needs (articulated) | Say aloud: "Throughout the procedure, I continuously observe the operative field, anticipate the surgeon's next requirements, monitor tissue condition and sterile field integrity, and prepare the required instruments or supplies before they are requested." | |||
| 12 | Support surgical count (articulated) | Say aloud: "I maintain awareness of all swabs, sharps, needles, and instruments throughout the procedure. During counts I assist the surgical team, respond immediately to discrepancies, and help ensure no surgical item remains in the operative field before closure." | |||
| 13 | Manage sutures, needles, and surgical materials | Load needles correctly when required, present sutures safely, maintain appropriate suture tension during running sutures, and anticipate additional materials as closure progresses. | Needles are loaded correctly, sharps are handled safely, suture tension remains consistent, and additional materials are prepared before they are requested. | Incorrect needle loading, inconsistent tension, unsafe sharps handling, releasing sutures too early, or delayed preparation may compromise wound closure. | Follow the surgeon's rhythm during suturing. Maintain steady tension without pulling excessively or allowing slack to develop. |
| 14 | Cut sutures or tie knots as directed | Cut the correct suture strand at the appropriate time and length without damaging the knot or disturbing wound approximation. | Sutures are cut accurately, knot security is maintained, tail lengths are appropriate, and wound alignment remains undisturbed. | Cutting the wrong strand, damaging the knot, leaving tails too long or too short, or cutting before instructed may compromise wound closure. | Pause briefly before cutting to confirm the correct strand and appropriate timing. Accuracy is more important than speed. |
| 15 | Assist with wound closure if directed | Maintain exposure during wound closure, support tissue approximation, anticipate closure materials, present instruments promptly, and assist until dressings are applied. | Exposure is maintained, wound edges remain aligned, tissues are handled gently, instruments and materials are provided promptly, and closure progresses smoothly. | Poor anticipation, rough tissue handling, inadequate exposure, delayed instrument delivery, or loss of wound alignment may compromise surgical closure. | Closure requires the same level of attention as the main procedure. Continue anticipating the surgeon's needs until the operation is complete. |
References
[edit | edit source]
| Authors | Ian-laurel |
|---|---|
| License | CC-BY-SA-4.0 |
| Organizations | SELF, ECSACONM |
| Cite as | "SELF/Perioperative Nursing/Surgical First Assistant/Psychomotor Skills Practice Instructions". Appropedia. 2026. Retrieved July 14, 2026. |