Perioperative Nursing Changes

Surgery can be the most troubling and stressful time for the patient during any medical procedure.  This is why the perioperative time is so critical to patients.  The time before surgery in which the patient is prepared both physically and mentally for their procedure can determine how effective and efficient the time in the operating room unfolds.  Of all the usually perioperative procedures, one of the most common occurrences that a patient will experience is the routine shaving of body hair in the area that will be operated upon in the form of incisions being made.  This process has been a routine for a long time and has not ever been changed or updated.  For many patients, depending upon where their surgery requires shaving, this can be one of the most traumatic experiences of the entire process because it acts as sort of a highlight of the area that the patient has had the surgery on.  This is not an action merely limited to routine shaving.  The field of information technology could do with a major overhaul in the entire process of the perioperative procedures, especially in regards of the flow of information between hospital filing systems.  By acting with the proper attention, compassion, and informing the patient why this needs to be done for the surgical purposes, a nurse can create an environment where the patient feels the most at ease and will thusly create a scenario for the surgery to be carried out with the greatest ease for both the operating doctors physically and the patient mentally.

The perioperative period is technically defined as “the preparation and management of a patient prior to surgery.  It includes both physical and psychological preparation,” (Encyclopedia of Surgery, n.d.).  This period is of the upmost importance because it is the time in which the entire operation is prepared and set up.  It has been shown statistically that his period has a direct correlation to the outcome of many surgical procedures in that patients that are better prepared for their surgeries tend to have more positive outcomes.  Obviously, with this in mind, those that provide the initial care to the patients before their surgery will have some of the most important responsibilities when it comes to monitoring and dealing with the patients ability to manage the stresses, both physically and emotionally, of their impending surgical procedures.  The individuals that provide the majority of the patient care during this time are nurses, specifically perioperative nurses.  Some of the major responsibilities that these individuals are charged with include running the basic vital tests, such as blood pressure, pulse, etc., making sure that the patient is properly checked in and registered in the hospital’s system, making sure that the proper amounts of anesthesia has been administered, and finally transportation of the patient from the initial care to the operating room (Spry, 2005).  

To properly care for patients during this time, nurses have to individually be ready to handle each and all patients under their care.  Some patients will want to be given as much information as possible about what is being done to them to understand and comprehend the situation they are currently in, while others will want the bare minimum about what is being done to them to help maintain a lower level of stress and anxiety about the procedure that is about to be performed on them (Encyclopedia of Surgery, n.d.).  Not only does this time period matter to the patient-staff relationship, but one providing this patient care must also realize that their efforts have the establishes resources at stake as well.  One must remember that this process is “aimes at enhancing the outcome from a surgical procedure and must be thorough, streamlined, educational, and cost-effective, with physician and patient satisfaction as the final goal,” (Shaw & Schwer, 2011).  Basically, the practicing nurse should realize that it is a combinatory effort on their part maximizes the entire events outcome for all parties involved.  

In terms of preparing the patient for surgery, the perioperative nurse should be ready to be very good teacher.  Though, as noted, there will exist some patients that are so stressed about their situation that they will not want to have the majority of the medical information explained to them in terms that they can understand, there will also exist a significant proportion of the patient population that will want to have ever last detailed explained and reasoned to them.  Clearly, the best choice of strategy for the care provider is to be ready to always explain every possible detail to the patient. Then, the element of bedside manner comes into perspective.  The nurse needs to be able to balance when and where the patient will want to have details as to why certain types of tests are be performed and certain diagnostics are being carried out.  Because one of the overall tasks assigned to the care provider at this stage of the medical procedures, the perioperative nurse does not want to overly stress out their patient by giving them too much detail about the reasoning and technical rational behind the testing purposes.

When it comes to potential improvements in the general application of techniques that can be applied by the perioperative nurses in terms of total patient care, there are only a few aspects that could really be improved.  First, the general bedside manner is always an aspect that can be further refined and improved upon.  The best example of how this aspect of the care giving process can be improved upon can be summarized by the example of routine body hair shaving prior to a surgical procedure.  The amounts of stress that a person can encounter from having a part of their body shaved adds greatly to the levels of stress that a person will encounter before and even after their surgical procedures.  It serves as a constant reminder to the patient about the procedure that they have had to encounter.  Additionally, there are certain parts of the body that people tend to feel more upset about when being shaved as compared to others.  For example, having one’s abdomen shaved for a surgery is not nearly as traumatic as having to have one’s head shaved for a surgery.  For the perioperative nurse, the task is to ease the stress that the patient will experience enduring this procedure.  This is where bedside manner is of the upmost importance.  The nurse must be able to clearly, calmly, while remaining assertive in telling the patient why the shaving is necessary for surgical purposes.

Another aspect that could be improved upon in the terms of procedure and protocol comes from the preparation of surgery specifically in regards to anesthesia.  In terms of applying the anesthesia, there are several important and complex issues to take into consideration.  One must consider the following: “surgical procedures ad administration of anesthesia are associated with a complex stress response that is proportional to the magnitude of injury, total operating time, amount of interoperative blood loss and degree of postoperative pain,” (Zambouri, 2007).  Taken this into consideration, the nurse should realize that there are 8 listed primary goals that must be considered and monitored compared to the application of anesthesia.  First, the proper documentation of all preexisting and apparent conditions pertaining to the impending surgery must be made.  Secondly, the care provider must make an accurate assessment of the patient’s overall health condition.  Third, the care provider must make a conscious effort to uncover and record any and all of the problems that could potential cause problems in all phases (before, during, and after) the surgery.  Fourth, the care provider must be able to make a risk determination for the patient prior to entering surgery.  Fifth, the care provider is charged with the responsibility of the optimization of the patient’s medical condition in the hopes to “reduce the patient’s surgical and anesthetic perioperative morbidity or mortality,” (Zambouri, 2007).  Sixth, the care provider is charged with the development of a care plan for the perioperative procedure that is appropriate and applicable.  Seventh, the care giver is charged with being a part of the education process for their patient before, during, and after the operation and must be able to help the patient effectively manage their stress and anxiety.  Finally, the care giver must be able to find ways in which they can reduce costs, shorten the time that the patient is in the hospital (both physically and in the system), and, generally, raise patient satisfaction (Zambouri, 2007).  

With these goals in mind, what the care giver can aim to eliminate comes down to three major areas.  First, the care giver can aim to “eliminate the wrong surgical procedure or surgery performed on the wrong body part, or on the wrong patient,” (ICSI, 2013).  Second, the care giver is charged with attempting to eliminate unintentionally having a patient retain any and all foreigh objects within their body from any surgical procedure.  Finally, the care giver is charged with the minimization of amount of infections that result from wounds inflicted during surgical procedures.  By aiming to eliminate these three areas by adhering to the 8 goals mentioned above the care giver can aim to “improve the adherence to the key components of the perioperative protocol,” (ICSI, 2013).                  

One of the other areas that can apply to the improvement of the perioperative procedures lies with the use of information technology throughout the entire process.  The modern era of technology holds many different areas that can be utilized in order to improve the speed and general efficiency of the perioperative process from both a clinician and patient stand point.  By adding a complex, thorough system for the quick and effective implementation of patient records, care givers will be able to quickly access the records of individuals and assess the medical problems that could potentially arise from surgery.  The implementation of these systems have become more and more apparent in the medical community, but a universal system needs to be applied between clinics in order to have seamless access of information and flow of communication between clinics for cases such as if a patient is receiving treatment in a hospital system that is on a different state than their homes.  The systems implemented however have neglected much of the perioperative care and too often have not placed priorities on the “unique requirements of perioperative care,” (Jacques & Minear, n.d.).  

The major issue that faces the implementation of the mentioned changes comes mostly from implementing a system that can be universal between clinics, care givers, and patients is the largest obstacle that faces the current health care providers in the perioperative field.  Currently, it can be extremely difficult for the caregivers in the perioperative field to understand and apply knowledge about their patients because they usually are meeting them for the first time when they are assigned to their care.  If a system that was universal between all clinical systems was in place, the nurses would be able to quickly access the information that would be necessary for making quick, effective decisions that could cut down on time, money, and other resources that are needed to run multiple, sometimes unnecessary tests.

The nurses and other caregivers of the perioperative stage of treatment all serve a very specific, important function.  The individuals in this field help to set up the patients for the remainder of their time in the hospital system, including postoperative stays. Pilot projects for aromatherapy in this stage have been conducted to further assist the patient.  Though these individuals spend all of the effort that they can on preparing their patients for surgery as effectively and efficiently as possible, the reality of the situation is that some definite improvements could be made to ease the job of the care givers and cut down on the spend of resources of all the hospitals.  By implementing the necessary changes, the overall speed and satisfaction of all the individuals involved, from patient to doctor, can be improved, and the role of the perioperative nurse, already of major importance, can be even more appreciated for the effective job that they perform.

References

Encyclopedia of Surgery. (2011). Perioperative care. The Encyclopedia of Surgery, Retrieved from http://www.surgeryencyclopedia.com/Pa-St/Preoperative-Care.html

ICSI. (2013). Perioperative protocol. Insitute for Clinical Systems Improvment, Retrieved from https://www.icsi.org/guidelines

Jacques, P. & Minear, M. (n.d.). Improving perioperative patient safety through the use of information technology. Retrieved from http://www.ahrq.gov/downloads/pub/advances2/vol4/Advances-StJacques_105.pdf

Responding to the needs of the perioperative client. (2001). Retrieved from http://webtools.delmarlearning.com/sample_chapters/0766824527.pdf

Shaw, H., & Schwer, W. (2011). Perioperative management of the female patient. Medscape, Retrieved from http://emedicine.medscape.com/article/285544-overview

Spry, C. (2005). Essentials of perioperative nursing. (3rd ed.). Retrieved from http://books.google.com/books

Zambouri, A. (2007). Perioperative evaluation and preparation for anesthesia and surgery. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464262/