Lesson 1Time-out process: components, team communication strategies, and documentationExplains the surgical time-out process, including required elements, role clarity, communication strategies, and documentation, emphasising how structured pauses prevent wrong-site surgery and align the team on patient, procedure, and safety concerns.
Core elements of the surgical time-outRoles of nurse, surgeon, and anaesthesiaVerbal confirmation and closed-loop talkAddressing discrepancies before incisionDocumenting time-out and late entriesLesson 2OR admission and identification procedures: patient transport, monitoring hookup, and baseline vitalsReviews safe OR admission processes, including patient identification, transport from pre-op, transfer to the OR table, monitoring hookup, and baseline vital sign documentation to ensure continuity of care and prevent identification or handoff errors.
Verification of patient identity and consentSafe transport and handoff from pre-opTransfer techniques and fall preventionInitial monitoring hookup and lead placementBaseline vitals and pre-induction assessmentLesson 3Intraoperative monitoring priorities for patients with HTN and T2DM: BP trends, glucose monitoring, temperature controlCovers intraoperative monitoring priorities for patients with hypertension and type 2 diabetes, including blood pressure trends, glucose control, temperature management, and early recognition of hemodynamic or metabolic instability during laparoscopic procedures.
Baseline assessment for HTN and T2DM risksNoninvasive and invasive BP trend monitoringIntraoperative glucose checks and insulin useTemperature monitoring and warming strategiesRecognising hemodynamic and metabolic red flagsLesson 4Skin prep and antisepsis specific to upper abdominal laparoscopyDetails evidence-based skin preparation and antisepsis for upper abdominal laparoscopy, including site assessment, hair removal, antiseptic selection, application technique, drying times, and strategies to prevent contamination during draping and port placement.
Pre-assessment of skin, scars, and infection riskHair removal methods and timingChoosing appropriate antiseptic agentsApplication patterns and required dry timesMaintaining prep integrity during drapingLesson 5Communication with surgeon and anesthesia: reporting, escalation, and crisis resource managementCovers structured communication between circulating nurse, surgeon, and anaesthesia provider, including routine reporting, escalation of concerns, and crisis resource management principles to support coordinated, safe intraoperative care in Botswana.
Standardised intraoperative reportingNotifying changes in vitals and trendsEscalating equipment or safety concernsClosed-loop communication in crisesUsing CRM principles during emergenciesLesson 6Sterile field maintenance: gowning/gloving, sterile draping for laparoscopy, trocar sites, and smoke plume managementFocuses on maintaining a sterile field during laparoscopy, including proper gowning and gloving, sterile draping techniques, trocar site management, and safe handling of surgical smoke to protect both patient and staff from contamination and exposure.
Assisted and self-gowning and glovingDraping sequence for upper abdomen casesMaintaining sterility at trocar insertion sitesHandling and passing laparoscopic instrumentsSmoke plume evacuation and filter useLesson 7Instrument and device management: laparoscopic instrument sets, electrosurgery, insufflation equipment, and portsExplores safe handling of laparoscopic instruments, electrosurgical units, insufflators, and ports, focusing on setup, function checks, troubleshooting, and collaboration with the surgical team to prevent injury, burns, or equipment-related delays.
Laparoscopic tray components and inspectionElectrosurgical unit setup and safety checksInsufflator setup, alarms, and pressure limitsPort selection, placement, and fixationCable, tubing, and cord organisationLesson 8Management of common intraoperative events: hypotension, bleeding, equipment failure, retained item protocolsAddresses recognition and nursing response to common intraoperative events, including hypotension, bleeding, equipment malfunction, and retained item risks, with emphasis on rapid communication, documentation, and adherence to safety and escalation protocols.
Assessment and response to hypotensionRecognition and control of intraoperative bleedingTroubleshooting critical equipment failuresRetained item risk factors and preventionEscalation pathways and event documentationLesson 9Counts protocol: sponge, instrument, and needle counts—timing, documentation, and discrepanciesOutlines standardised counting procedures for sponges, instruments, and sharps, including timing, documentation, and steps for resolving discrepancies, to prevent retained surgical items and support accurate, legally sound records in Botswanan ORs.
Initial, intraoperative, and final count timingRoles and communication during countsDocumentation requirements and count sheetsManaging count discrepancies and searchesUse of adjunct technologies for countsLesson 10Positioning for laparoscopic cholecystectomy: supine with Trendelenburg/tilt, padding, pressure point protection, and hemodynamic implicationsDescribes safe positioning for laparoscopic cholecystectomy, including supine with tilt variations, padding and pressure point protection, securing the patient, and understanding hemodynamic and respiratory effects of position and pneumoperitoneum.
Pre-positioning assessment and planningSupine and reverse Trendelenburg setupLateral tilt and table adjustmentsPadding, straps, and nerve protectionHemodynamic and respiratory implications
