Clinical Decision-Making During Wound Closure

Abstract

Aims: To explore how operating room nurses (ORNs) make clinical decisions during surgical wound closure, a delegated act for which they are legally authorized but often constrained in practice. Materials and Methods: A qualitative exploratory–descriptive study was conducted with 14 ORNs working in public and private surgical facilities in northern France. Individual semistructured interviews were carried out between February 2025 and March 2025. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s reflexive thematic analysis. COREQ guidelines informed reporting. Results: Six themes were identified. ORNs primarily developed wound closure skills through experiential learning rather than formal training. Their autonomy was conditional, shaped by institutional protocols, surgeon expectations, and hierarchical dynamics. Trust and familiarity within surgical teams determined whether nurses could take initiative or adapt closure techniques. Institutional factors—such as operating room turnover and prioritization of surgical residents—limited opportunities for nurse-led closure. Many ORNs reported low recognition of their role, leading to professional invisibility. Despite these constraints, some ORNs demonstrated patient-centered reasoning, adapting closure methods to individual characteristics when possible. Conclusion: ORN decision-making during wound closure reflects a persistent tension between legal authorization and limited enacted autonomy. Enhancing nurse-led closure practices requires clearer protocols, improved interprofessional recognition, and educational strategies that integrate both technical and judgment-based competencies.