Comprehensive Essay: Roles Of Nursing Professionals In Perioperative Care.

Pre-admission Clinic Nurse

Discuss About The Comprehensive Thorough Health Of The Patient.

The case study being discussed here is about a seventy year old female Gail, who has been admitted to the surgical ward following an incident that involved a mechanical fall. Mechanical falls are most commonly found to occur due to trips, slips, or loss of balance.  An x-ray scan confirmed the presence of femoral neck fracture in the right leg. Femoral neck is the weakest region of the femur and these fractures are generally considered subsets of proximal femoral fractures (Langslet, Frihagen, Opland, Madsen, Nordsletten & Figved, 2014). Elastic resistance also reduces in the bones that have been fractured. This essay will elaborate on six nursing roles, involved in perioperative care (Hamlin, Davies, Richardson-Tench & Sutherland-Fraser, 2016).

Pre-admission clinic nurse will be involved in complete a comprehensive and thorough health assessment of the patient, with the aim of ensuring her readiness for the orthopaedic surgery (LeMone, Burke, Dwyer, Levett-Jones, Moxham & Reid-Searl, 2015). The role of the nurse encompasses using a set of questionnaires and conducting a range of tests during the visit, followed by making the results available to the general practitioner and treating specialist. One major role of the pre-admission clinic nurse would be to work in collaboration with the anaesthetic and surgical team for ensuring maintenance of optimal health of the patient and preparing the latter for admission (Bouamrane & Mair, 2014). Further duties include paperwork regarding the medical history of the patient and medical insurance, failure to record which can lead to legal disputes. Moreover, the assessment will also involve infection control by assessing the patient for the presence of nosocomial infections due to the fall.  

Day-stay unit nurses are entitled with the duty of providing care to their respective patients for a time period of 24 hours or less, across different settings. The same-day nurses will care for Gail before and after the same-day surgery. The role would encompass using cost-effective ways for promoting patient health, managing acute or chronic health problem or preventing health deterioration. She would also promote self-management of the patient and assist the latter’s friends and family members in taking care of the patient. Following preparation of the patient for the operation theatre, patient recovery will also be looked after by this nurse (Wright, Tan, Iliffe & Lee, 2013). Removing hair from the surgical site and using depilatory creams, and dressing surgical sites are some essential infection control practices performed by these nurses. Furthermore failure to monitor the patients or keep a check on their complications can lead to legal trouble.

Day-stay Unit Nurse

Anaesthetic nurses are clinically trained and have the necessary educational credentials for providing care to patients requiring an anaesthesia or pain management, before a surgery is performed. The nurse will also be involved in administration of the anaesthetic and preparing the required equipment. In addition, the patient’s condition will also be monitored, along with presence of adverse reactions in response to the anaesthetic. Legal aspects of the duty encompass the fact that administration of wrong anaesthetic or inappropriate doses can lead to medical malpractice and result in lack of oxygen, awakening or death (Brykczynski, 2014). Decontaminating the surgical equipment, cleaning materials, disinfection practices, and hand hygiene practices are some of the steps that are expected from the anaesthetic nurse before and after the surgery (Crosson, 2015).

The duties of a circulating (scout) nurse are generally conducted outside the sterile region. The CN will manage all important care inside the operation theatre and will provide assistance to the team with the aim of maintaining and creating a comfortable and safe environment for the patient. The nurse will have the duty of alerting the surgical team with the aim of ensuring the presence of adequate surgical supplies, following which they will be sent to the operation theatre. She will also be imperative in managing and documenting the supplies, collecting patient specimen (Russ et al., 2015). Verifying the consent form of Gail and authenticating accountable items are essential legal roles, failure to fulfil which, will result in violation of patient safety (Lamont, Jeon & Chiarella, 2013). Preparing the surgical equipment and avoiding intra-surgical complications are some of the infection control practices encompassed by the duty of a scout.

A scrub nurse ensures that all equipment in the operation theatre are clean and ready for use, upon patients. She will be responsible for handling the tools and equipment to the orthopaedic surgeon. Furthermore, she will also have to rapidly and efficiently response to the requests and hand gestures of the doctors and the surgeon. A legal complication can arise if the instrument nurse fails to check whether the equipment are updated and ready to use. Sudden technical faults of the equipment during the surgery can threaten patient safety. Furthermore, sterilization of equipment is also encompassed by her role, the primary benefit of which is related to prevention of infection transmission (Jacob, Li, Akingba & Wachs, 2013). Failure to provide sterile supplies and inattentiveness towards intraoperative complications will also encroach upon patient safety.

Anaesthetic Nurse

PACU nurses have the responsibility of monitoring post-operative patients, following their recovery from surgeries in an outpatient setting or a hospital. The nurse will be involved in managing the vital signs, changing the dressing bandages, and administering the necessary medications. Furthermore, she would also be in charge of getting a comprehensive handover from surgical teams and monitoring the patient all along the perioperative journey. Management of postoperative pain and taking appropriate steps for nausea relief are other essential duties of the nurse (Hayes & Gordon, 2015). Legal complications arise when these nurses fail to ensure opening of the patient’s airway, and taking regular observations of the patient. Furthermore, a PACU nurse will also have the role of maintaining proper hand hygiene practices in the recovery room, which when not followed might increase risks of infection.

Thus, it can be concluded that the outcomes of the surgery that is intended to be conducted on Gail for femoral neck fracture do not depend only on the surgeon, but on several nursing professionals namely, pre-admission clinic nurse, day stay nurse, anaesthetic nurse, scout nurse, scrub nurse, and PACU nurse. All these nurses adorn the role of a caregiver and have the prime duty of providing hands-on care to all patients in a variety of healthcare settings. Thus, their role would entail assessing the physical needs of the patient, in addition to helping in illness prevention, maintaining patient safety and preventing pathogen transmission.

References

Bouamrane, M. M., & Mair, F. S. (2014). A study of clinical and information management processes in the surgical pre-assessment clinic. BMC medical informatics and decision making, 14(1), 22. https://doi.org/10.1186/1472-6947-14-22

Brykczynski, K. A. (2014). Role Development of the Advanced. Advanced practice nursing: An integrative approach, 86. Retrieved from- https://books.google.co.in/books?hl=en&lr=&id=aafPeFGT6uoC&oi=fnd&pg=PA86&dq=anesthetic+nurse+role&ots=b4Yq6X3HsD&sig=e-WDNQHBO710vfyovxFXA0DuziU#v=onepage&q=anesthetic%20nurse%20role&f=false

Crosson, J. A. (2015). Keeping patients safe: the importance of collaboration. AORN journal, 101(2), 279-281. https://doi.org/10.1016/j.aorn.2014.11.006

Hamlin, L., Davies, M., Richardson-Tench, M., & Sutherland-Fraser, S. (2016). Perioperative Nursing-EBook-epub: An Introduction. Elsevier Health Sciences. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=_cr1CwAAQBAJ&oi=fnd&pg=PP1&dq=Perioperative+Nursing,+an+introduction,+edited+by+Hamlin,+L.,+Davies,+M.,+Richardson-Tench,+M.,+%26+Sutherland-Fraser,+S.+2nd+edition,&ots=Ebu8vYeYKa&sig=bNdw1KDSx7wjszL83LFwXaIKbOI#v=onepage&q=Perioperative%20Nursing%2C%20an%20introduction%2C%20edited%20by%20Hamlin%2C%20L.%2C%20Davies%2C%20M.%2C%20Richardson-Tench%2C%20M.%2C%20%26%20Sutherland-Fraser%2C%20S.%202nd%20edition%2C&f=false 

Hayes, K., & Gordon, D. B. (2015). Delivering quality pain management: the challenge for nurses. AORN journal, 101(3), 327-337. https://doi.org/10.1016/j.aorn.2014.11.019

Jacob, M. G., Li, Y. T., Akingba, G. A., & Wachs, J. P. (2013). Collaboration with a robotic scrub nurse. Communications of the ACM, 56(5), 68-75. doi: 10.1145/2447976.2447993 

Lamont, S., Jeon, Y. H., & Chiarella, M. (2013). Assessing patient capacity to consent to treatment: An integrative review of instruments and tools. Journal of Clinical Nursing, 22(17-18), 2387-2403. https://doi.org/10.1111/jocn.12215

Langslet, E., Frihagen, F., Opland, V., Madsen, J. E., Nordsletten, L., & Figved, W. (2014). Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clinical Orthopaedics and Related Research®, 472(4), 1291-1299. https://doi.org/10.1007/s11999-013-3308-9

LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., & Reid-Searl, K. (2015). Medical-surgical nursing. Pearson Higher Education AU. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=MDXiBAAAQBAJ&oi=fnd&pg=PP1&dq=lemone+and+burke+3ed+&ots=UI7T8DeY79&sig=KR_D81r04DgUv6LMWox3h51kIus#v=onepage&q=lemone%20and%20burke%203ed&f=false 

Russ, S., Rout, S., Caris, J., Mansell, J., Davies, R., Mayer, E., ... & Sevdalis, N. (2015). Measuring variation in use of the WHO surgical safety checklist in the operating room: a multicenter prospective cross-sectional study. Journal of the American College of Surgeons, 220(1), 1-11. https://doi.org/10.1016/j.jamcollsurg.2014.09.021

Wright, P. N., Tan, G., Iliffe, S., & Lee, D. (2013). The impact of a new emergency admission avoidance system for older people on length of stay and same-day discharges. Age and ageing, 43(1), 116-121. https://doi.org/10.1093/ageing/aft086