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Clinical Decision-Making During Wound Closure: A Qualitative Study Among Operating Room Nurses in France
1Associate Professor of Nursing, Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales (Kind, Quindroit); Operating Room Nurse, Operating Room Nursing School, Loos, Lille, France (Kind).
Clinical Nurse Specialist CNS
|August 5, 2026
Summary
Operating room nurses (ORNs) face challenges in clinical decision-making during surgical wound closure due to conditional autonomy. Enhancing their role requires better protocols and interprofessional recognition.
Area of Science:
- Nursing Practice
- Surgical Care
- Clinical Decision-Making
Background:
- Operating room nurses (ORNs) are legally authorized to perform surgical wound closure.
- Practice constraints often limit ORNs' autonomy in this delegated act.
Purpose of the Study:
- To explore the clinical decision-making processes of ORNs during surgical wound closure.
- To understand the factors influencing ORNs' autonomy and practice in wound closure.
Main Methods:
- Qualitative exploratory-descriptive study involving 14 ORNs in France.
- Semistructured interviews analyzed using reflexive thematic analysis.
- Study adhered to COREQ guidelines for transparent reporting.
Main Results:
- ORNs primarily gain wound closure skills through experience, not formal training.
- Autonomy is influenced by protocols, surgeon expectations, team dynamics, and institutional factors.
- Nurses demonstrated patient-centered reasoning but faced professional invisibility and limited opportunities.
Conclusions:
- ORN decision-making in wound closure highlights a gap between legal authority and actual autonomy.
- Improving nurse-led closure requires clearer protocols, enhanced interprofessional recognition, and integrated education.
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