ne of the most importantone-word sentences thatexists is “Why?” It stimu-lates thought, leads thequest to find answers, and

helps solve problems. Children innate-ly ask why so frequently that it candrive their parents crazy, but adultsoften lose this curiosity.

In today’s evidenced-based practiceenvironment, this question is evenmore important. Nurses often blanchwhen they hear the word research orare asked to undertake a qualityimprovement project. Students getweak in the knees when they learn oneof their assignments is to investigate atheory and develop a hypothesis abouta topic. These activities, however, areall rooted in the “why” of something.

TEACHING STRATEGYSocrates, an Athenian philosopher

who lived from 469 to 399 BCE (ie,before the common era),1 used a ques-tioning strategy when teaching a groupof elite and arrogant young men. Toteach them to think, he asked ques-tions rather than providing answers.1

This method of teaching is powerful,and it still is being used today toencourage thinking and creativity.2

Today, there also are books and websites3 that answer the “why” of things,and more people are turning to theInternet to find answers. This can begood; however, not everything that isposted on the Internet is factual. Factsneed to be questioned and evaluated.4

A “WHY” CLINICAL SITUATIONIt has been said that one must ask

“why” five times to get to the root of asituation or problem. This became truefor me when I worked as a periopera-tive clinical nurse specialist. I wascalled to the postanesthesia care unit

(PACU) to hear a complaint regardingthe perioperative nurses. It seemedthat they constantly sent patients tothe PACU on a stretcher that was bro-ken (ie, the head could not be raised).This restricted the PACU nurses fromraising the head of the bed whenmanaging a patient’s airway or help-ing them to wake from anesthesia. Thenurses in the PACU complained to theOR, but the problem was not resolved,and they wanted me towrite a new policy onsending patients torecovery. Before proceed-ing further, I started toask five “why” ques-tions.• I asked the OR nurse

why she had put thepatient on a brokenstretcher. The nursesaid it was because itwas the stretcher out-side the room. Shewas not aware it wasbroken and did nothave time to look foranother stretcher.

• I asked the OR director why a bro-ken stretcher was being used. Shesaid that it is what the transportersbrought.

• I asked the transporters why theybrought a broken stretcher. Theysaid they had reported the problemto maintenance several times andeven put a sign on it, but when theOR called, the broken stretcher wasthe only one available.

• I asked maintenance why they didnot repair the broken stretcher. Theyreplied that they had ordered a partand it had not yet come in. Therewere not enough stretchers, so thebroken one was used.

• I asked purchasing why the part for

AORN JOURNAL • 961

Editorial DECEMBER 2005, VOL 82, NO 6

Never underestimate theimportance of asking “why?”

E D I T O R I A L

Nancy J. Girard,RN

OIt has been saidthat one mustask “why” fivetimes to get tothe root of a situation or

problem.

962 • AORN JOURNAL

DECEMBER 2005, VOL 82, NO 6 Editorial

the stretcher had not comein yet. They said that partwas obsolete and couldnot be replaced.

I put in a proposal to ordernew stretchers. The proposalwas approved and thissolved the problem.

LESSON LEARNEDThe lesson I learned was

to ask the question “why”and not settle for an unre-searched solution (eg, accus-ing the perioperative nursesand putting another policy orprocedure in place).Perioperative nurses aresmart, clever, and creative;however, they live in a pre-scriptive environment whereevery action is preplannedand every thought has aguideline. Sometimes, nursesbecome so accustomed tohaving clear directions forevery step of every processthat they forget to ask why

they are doing it. The theorybehind the action is forgottenin the automatic habits forgedin the OR. When habits takeover thinking, anything out-side the norm can be confus-ing, and the correct action canget lost. The reason some-thing is done can be missedin the translation from theoryto action.

AORN helps perioperativenurses by preparing guide-lines and recommended prac-tices that are developed byasking why and using themost recent evidence for bestpractices. The cognitive abilityof perioperative nurses tothink and ask why, however,remains the most effectivetool we have. The excellentresearch and quality improve-ment articles published in theAORN Journal demonstratethe inquisitive nature of prac-titioners. In translating thesenew ideas or any information

into practice, perioperativenurses must ask why andevaluate their findings. ❖

NANCY J. GIRARDRN, PHD, FAAN

EDITOR

NOTES1. “Socrates,” Philosophy Pages,http://www.philosophypages.com/ph/socr.htm (accessed 24 Oct2005).2. “Socratic teaching,” FresnoCounty Office of Education:California Pass Program, http://www.cyberhigh.fcoe.k12.ca.us/PASS_Program/methodology/Socraticteaching.htm (accessed 24 Oct2005). 3. “The why files top 5,” TheWhy Files: University ofWisconsin Board of Regents,http://whyfiles.org (accessed 24Oct 2005).4. “Evaluating web pages:Techniques to apply & questionsto ask,” University of CaliforniaBerkeley Library, http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/Evaluate.html (accessed24 Oct 2005).

More than one million medication error recordshave been received by MEDMARX, the largest

nongovernmental database of medication errors,according to a Sept 27, 2005, news release fromthe United States Pharmacopeia (USP). Hospitalsand related institutions nationwide contributedata to MEDMARX to report, track, and analyzemedication errors. Although hospitals have docu-mented medication errors for years, the MEDMARXtool standardizes collection, facilitates analysis,and enables risk prevention through access to thecentral repository of all errors submitted by par-ticipants. The database represents the first timesuch information has been shared for learningpurposes.

More than 900 health care facilities have con-tributed data since the Internet-based program

began in 1998. The USP expanded the program inSeptember 2004 to collect, analyze, and disseminateinformation on adverse drug reactions to help hospi-tals reduce morbidity and mortality.

A historical review of MEDMARX data showsthat approximately 46% of the medication errorsreported reached the patient, but 98% of reportederrors did not result in harm. Using data from theMEDMARX program, the USP’s Safe Medication UseExpert Committee has issued recommendationsregarding labeling, packaging, nomenclature, andother areas affected by medication errors.

USP’s National Adverse Drug Event Database Hits OneMillion Records Milestone (news release, Rockville, Md:The United States Pharmacopeia, Sept 27, 2005) http://www.usp.org/aboutUSP/media/ (accessed 29 Sept 2005).

One Million Records Entered in Medication Errors Database