Ethics, Consent, and Interprofessional Coordination for Orthodontics Removable Appliance Care Under General Anesthesia: A Qualitative Phenomenological Inquiry Involving Operating Rooms, Nursing Specialists, Nursing, Pharmacy, Anesthesia Technicians, and Health Administration

Abstract

The provision of orthodontic care involving removable appliances under general anesthesia (GA) presents unique ethical and interprofessional challenges, particularly within complex surgical settings that rely on collaboration among diverse healthcare professionals. This study was driven by a need to understand the lived experiences of those involved in this type of care, especially as informed consent, professional role boundaries, and interdepartmental coordination remain critical yet under-explored areas. Although institutional protocols for consent and collaboration exist, discrepancies between policy and real-world implementation often result in ethical ambiguity and procedural inefficiencies. To address this gap, a qualitative phenomenological methodology was employed, drawing on Husserlian principles to explore the essential meanings of experience from the perspective of healthcare providers. Data were collected through semi-structured, in-depth interviews with 26 participants across five disciplines operating room nurses, anesthesia technicians, dental surgical assistants, pharmacy technicians, and health administrators from three tertiary hospitals in Saudi Arabia. Participants were selected through purposive sampling based on their direct involvement in orthodontic cases performed under GA and a minimum experience threshold. Analysis of the transcribed interviews revealed three major themes: ethical tensions in the informed consent process, interprofessional role ambiguity, and coordination and communication barriers. Subthemes included proxy decision-making, language-related consent difficulties, misaligned team responsibilities, and documentation inconsistencies. These findings underscore the need for improved communication protocols, clearer role definitions, and ethically responsive consent procedures that reflect the cultural and linguistic diversity of patient populations. The study contributes a foundational understanding for improving policy, ethics education, and collaborative practice in surgical orthodontics.