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Preoperative Nursing Elective Assignment Help
This is a solution of Preoperative Nursing Elective Assignment Help in which we discuss nurses to protect people and reduce risk in preoperative settings would be discussed.
Perioperative environment has been found to be a high risk area for patients since several medical errors can occur in the operating room that may severely harm the patients. It is extremely essential for health and care professionals to ensure safety of patients in operating room, prevent medical errors and protect them from being harmed. This essay depicts the causes of enhanced vulnerability of patients in the operating room and the challenges that exist in there for the nurses. Along with this, the steps and strategies taken by nurses to protect people and reduce risk in perioperative settings would be discussed.
Perioperative nursing can be explained as providing nursing care to patients before, during and after an invasive procedure or surgery. It may be practiced in several areas including operation theatres, interventional radiology suites, endoscopy suites, trauma units etc.
Operating room is an area where multiple professionals work together simultaneously to provide surgical care and treatment to the patient putting a lot of stress and pressure on the patient. The whole environment is full of anxiety for the patient as well as health professionals making it quite vulnerable for medical errors to occur. Patients undergoing surgery are found to come under vulnerable population, that is, the people who are at risk of poorer health status and poorer final outcomes in comparison to other people (Landrigan, et al, 2010). There are several surgical and medical errors including medication error that may readily occur in perioperative environment and may pose serious threat to patient’s health. The high risk carried by operating room along with already debilitating condition of patient makes them more vulnerable to get infections or harmed and therefore, expects nurses to deliver high quality of care services to ensure patient’s health and safety. Nurses need to understand that this vulnerable population needs special care and attention as they are very prone to conditions like surgical site infection or other post operative complications and are under high stress owing to their past experiences. Their high anxiety is manifested in the form of physical and psychological symptoms that further increase their risk of getting harmed in anesthetic, surgical or post operative procedures (McMillan & Hubbard, 2012).
It has been found that perioperative environment comprises of multiple surgeons for a case who are usually expected to perform multiple procedures in a visit and have time pressures to complete the surgery in a destined period. This increases the chances of occurrence of errors like misidentification of patient, misidentification of surgical site, wrong level of surgery performed, medication errors, etc. Thus, it becomes really important for service providers to understand this vulnerability of patients in perioperative rooms, identify its presentation in patients and take effective steps to manage the symptoms (Riddle and Stannard, 2014).
Almost every patient who is being hospitalized is found to come under vulnerable population, however, the degree of vulnerability varies for every other person depending on different variables like social, psychological or physical state of the person (Cousley, 2015). The demographic, cultural and economic demand of a person that cause his illness measure the social vulnerability. This social vulnerability is driven by a person’s own capacity to deal with different circumstances which is basically affected by variables like one’s age, gender, income, educational status and minority status. Psychological vulnerability is one which is driven by the mental state of a person and thus, increases with the stress and anxiety level of a person. In a perioperative environment, patient faces a lot of stressors like fear of pain, fear of not waking up from anesthesia, outcome concerns, etc that ultimately have negative effects upon overall health status. Third major dimension is the physical vulnerability of a person that is if a person is already having a compromised physical state, his ability to cope up trauma or harm reduces making him more prone to get harm.
Thus, it may be said that, a perioperative environment makes a person vulnerable to harm due to several factors like his already compromised physical state, high stress and anxiety level, phobias, negative past experiences, high pressure of performance on health professionals including nurses, high risk of occurrence of medical and surgical error and presence of sophisticated technologies, various instruments, supplies, implants etc in the operating room that too are highly difficult to be managed. So, managing and taking good care of patients in such setting is a very challenging job for nurses.
Vulnerability of people to be at risk of harm in perioperative environment has been identified and well considered now and several positive strategies have been recommended to increase patient safety in such settings. Nurses, at present, are trained and educated about this vulnerability and have started taking active actions in a direction to reduce risk for the patients. It has been found that the first and foremost essential thing is to understand the concept of vulnerability so as to identify cases and address their nursing and care needs. The awareness about patient vulnerability is increasing on a daily basis and nurses have started to understand that almost every other person coming for the surgery is at risk in one or the other way. Although, few groups are at high risk like children, elderly adults, disabled people or people with communication problems, but still every patient’s safety are being ensured by nurses. They are being trained to identify anxious patients’ symptoms that greatly help them in recognizing high risk group people (Cousley, 2015). There are several physical signs along with behavioral changes in patients which are indicative of their anxiousness and vulnerability as they may be sweating or trembling, may have raised heart beat, pulse rate and other altered vital signs, may become unusually quite or very talkative which are recognized by health professionals and are addressed to relieve their stress level and enhance recovery rate.
Following identification of indicative signs of vulnerable patients, nurses manage these patients through their knowledge and skills. Their main aim is to relive patient’s stress and calm them down so as to reduce the risk of harm like postoperative complications and speed up their recovery. Communication is found to be an extremely helpful tool for managing patients in perioperative environment and through effective and friendly communication nurses can reduce patient anxiety up to a great level (Halverson, et al, 2011). Nurses talk to their patients, encourage them to ask questions or discuss their doubts, clear them, quench their queries and make them aware of the procedure and the positive outcomes of the whole treatment plan. Actually, nurses stay in more contact with the patients than the physicians or surgeons, thus, they are the one who need to make them comfortable and should have enough knowledge and skills to fill the information gap. They need to be well informed about patient’s condition, treatment plan and prognosis and should be able to explain all this in simpler terms to reduce overall stress and risk.
Management of perioperative patients and ensuring their safety is a very challenging task. Nurses already have a lot of pressure to perform, heavy work load, tiring shifts and long working hours. Thus, in order to improve the quality of care services, it is also mandatory to increase the ratio of nurses to patients, reduce their working hours and overall workload. This would not only improve their performance and efficiency but would also have positive impact on overall patient safety. In addition, their performances should be regularly reviewed through inspections, feedbacks, etc and they must be encouraged and trained to overcome their weakness and limitations to assist them to deliver best quality services. This would greatly improve their work efficiency and would help in reducing medical or surgical errors up to a great extent (Partridge, et al, 2012). They can well monitor the patients’ preoperative and perioperative conditions, manage their records, connect well with patients and also help in minimizing surgical errors like misidentification of surgical site, etc.
Nurses have become more and more responsible towards protection of patients in clinical settings and keep on taking efforts to maintain a quiet, comfortable and relaxed environment for them. Their experience and knowledge help them in having a preventive thinking and a future view to imagine things that can go wrong and thus, prevent them through usage of guidelines and checklists. They have started following a patient centered approach where individual needs and demands are identified, taken into consideration and addressed to ensure patient satisfaction and best care services. Patients’ expectations are managed in a way to build up their confidence on nurses and other health service providers (Story, et al. 2010).
Another essential factor is adopting team work in operating room by nurses. The importance of team work for strengthening safety elements in the perioperative environment and improving nursing performance cannot be overlooked (Johnson and Kimsey, 2012). Nurses are trained to divide their work as per their comfort and expertise zone and then coordinate with each other to deliver quality services. They have adopted qualities like working together with mutual trust and cooperation; have care skills, interpersonal skills, critical thinking, decision making skills and technical skills for maintaining patient safety and take good care of them (Weaver et al, 2010).
A universal protocol has also been released to minimize and prevent medical errors in the surgical room. The three principal components of this protocol, if followed, can greatly reduce the risk of harm to patient in operating room through surgical errors. Firstly, the health care team involves in a verification process where all patient’s record, data and equipment are present, clearly labeled and matched with the patient and are reviewed (Joint Commission, 2009). Following this, the correct operative site is marked and finally a ‘time out’ is performed before the procedure to avoid any surgical error. Nurses have been educated about this universal protocol so that they may extend their support and cooperation to other health professionals and help them to abide by these guidelines.
In addition, a surgical safety checklist has also been published by World Health Organization based on an international program for safe surgery and safe lives of patients. This checklist is reviewed and followed by nurses to make sure that patient is well protected in operating setting (WHO, 2009). It requires nurses to verbally confirm patient, operating site and procedure; to ensure sterility of all equipments and room, count instruments, needles etc before patient leaves the room to avoid foreign object retention ,etc, recording procedure name, etc. (Peregrin, 2010). Abiding by this safety checklist is an extremely helpful tool to reduce patient vulnerability in perioperative environment.
Along with these steps, nurses also help in minimizing patient’s risk of harm through positive steps like patient advocacy. They help in solving perioperative conflicts by actively involving in their advocacy and reduce distress level. They adhere to legal guidelines, adopt an evidence based practice, work ethically and have multidimensional communication with patients and family members (de Vries, et al 2010). They ensure that distractions like radios, telephone calls, and other unimportant activities are kept at minimum in the surgical room for improving surgical accuracy and efficacy. Thus, it can be said that several positive strategies have been adopted by health professionals including nurses to take good care of patients, treat them well and ensure their safety in the complex surgical environment.
Perioperative care is a complex and challenging job since patients are at high risk of getting infections, or other harm in such settings. Patients scheduled to undergo surgery are medically compromised and over that, reported to have high stress level that negatively affect their recovery rate. They are at high risk of post operative complications and occurrence of medical or surgical errors and therefore require special care and monitoring in the surgical room. This enhanced vulnerability of patient is being identified and several steps are taken to minimize the risk and increase patient safety. Nurses are trained and educated to identify patient’s stress symptoms, decrease their anxiety level and support health professionals so as to get best surgical outcomes and improve recovery rate of patients.
Cousley, A., (2015). Vulnerability in perioperative patients: a qualitative study. Journal of Perioperative Practice. December, Vol 25(12), pp 246-254.
de Vries EN, Prins HA, & Crolla RMPH, et al (2010). Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med ;363:1928-37.
Halverson, A.L., Casey, J.T., Andersson, J. et al, (2011). Communication failure in the operating room.Surgery.;149:305–310.
Johnson, H. and Kimsey, D. (2012) Patient Safety: Break the Silence. AORN Journal Volume 95, Issue 5. http://dx.doi.org/10.1016/j.aorn.2012.03.002
Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ (2010). Temporal trends in rates of patient harm resulting from medical care. N Engl J Med ;363:2124-34.
McMillan GJ, Hubbard RE. (2012) Frailty in older inpatients: what physicians need to know. Quarterly Journal of Medicine ; 105:1059–65.
Partridge JS, Harari D and Dhesi JK. (2012). Frailty in the older surgical patient: a review. Age and Ageing; 41: 142–7.
Riddle, D. and Stannard, D. (2014). Evidence in Perioperative Care, Nurs Clin North Am. ;49(4):485-92. doi: 10.1016/j.cnur.2014.08.004.
Hubbard, R. and Story, D. (2013). Patient frailty: the elephant in the operating room. Anaesthesia: Special Issue: Anaesthesia for the Elderly January 2014 Volume 69, Issue Supplement s1
Peregrin T. (2010). Checklists for success inside the OR and beyond: an interview with Atul Gawande, MD, FACS. Bull Am Coll Surg. ;95:24