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TRANSCRIPT
Developments in Surgical
nursing: A Global perspective
Professor Joy Notter
Birmingham City University
History of surgical nursing
• Difference in surgical and
medical nursing
recognised from late 19th
/ early 20th century as
nursing role became
established and surgical
possibilities increased
• At same time in USA
parallel role -anaesthetic
nurses spread to other
countries – still separate
Non-ward Surgical nurses
• This role of surgical
nursing was in
operating room
• Mainly cleaning and
preparing the room
• Practical training not
formal courses
• But acceptance of
ability to prepare
instruments
Florence Nightingale
• Formalised nurse education
and training
• Start of development of
national programmes
• Previously no consistency
• Two kinds of surgical
nursing
– Surgical nursing mainly in
operating theatre
– Nursing patients on surgical
wards taught as separate
aspect of training
Surgical nursing
• 1930s nurses taught general programme which
include medicine and surgery. Although wards
increasingly separated into medicine and surgery
• 1960s start of specialisation extending role of
nurses in surgery
• 1970s courses for specialist nurses
• 1980s move towards advanced practice and
higher degrees
• 1990s masters level advanced practice and
nurse consultant roles
Today in USA: Circulating Nurse
• S/he is in charge of the operating theatre
• Manages the care of a patient during surgery;
• Ensures the sterile integrity of the operating
room, equipment, and materials;
• Enters data that records the procedures;
• Assesses the patient’s condition
– before, during, and immediately following surgery.
Education for circulating nurse
• Initial nursing degree
• Post-qualifying
period in practice
• Specialist surgical
nursing training or
degree
• Operating room
training certificate
Recently Change in title in some
countries to reflect role
Surgical nursing Perioperative nursing
What is meant by
perioperative nursing?
Perioperative nursing is a term
used to describe nursing through the
entire span of surgery, including what
occurs before, during, and after the
actual operation.
Phases of perioperative nursing
Preoperative: begins with the decision to perform
surgery and continues until the client has reached the
operating area.
Intraoperative: includes the entire
duration of the surgical procedure, until
transfer of the client to the recovery area.
Postoperative: begins with admission to the recovery area and
continues until the client receives a follow up evaluation at home, or is
discharged to a rehabilitation unit.
:
Preoperative
III. Review preoperative laboratory
and diagnostic studies
II. Review the client’s health history
and preparation for surgery
I. Assess physical needs
IV. Assess psychological needs
V. Assess cultural needs
• Ability to communicate
• Vital signs
• Level of consciousness
• Confusion
• Drowsiness
• Unresponsiveness
• Weight and height
• Skin integrity
• Ability to move/ ambulate
• Level of exercise
• Prostheses
• Circulatory status
I Assess physical condition:
• History of present illness and reason for surgery
• Past medical history
• Medical conditions (acute and chronic)
• Previous hospitalization and surgeries
• History of any past problem with anesthesia
• Allergies
• Present medications
• Substance use: alcohol, tobacco, street drugs
• Review of system
I. Check documentation of the client’s
health history and preparation for surgery:
• Complete blood count.
• Blood type and cross match.
• Serum electrolytes.
• Urinalysis.
• Chest X-rays.
• Electrocardiogram.
• Other tests related to procedure or client’s medical
condition, such as: prothrombin time, partial
thromboplastin time, blood urea nitrogen, creatinine, and other radiographic studies.
II. Check preoperative laboratory and
diagnostic studies
• Emotional state
• Level of understanding of surgical procedure, preoperative and
postoperative instruction
• Coping strategies
• Support system
• Roles and responsibilities
IV. Assess psychological needs:
• Language-need for interpreter
• Specific family/ cultural patterns
• Gender issues in care
• Specific dietary needs
• Special religious needs
V. Assess cultural needs:
Intraoperative
II. Intraoperative nursing
I Type of surgery
• Diagnostic → Removal and study of tissue to make a
diagnosis
• Exploratory → Most extensive means to involve exploration
of a body cavity or use of scopes inserted though small
incision.
• Curative → Removal or replacement of defective tissue to
restore function.
• Palliative→ Relief of symptoms or enhancement of function
without cure.
• Cosmetic→ Correction of defects, improvement of
appearance, or change to a physical feature.
Type of surgery
Intraoperative nursing
• Prepare/ check operating room
• Prepare sterile packs
• Set and check instruments
• Assist surgeon or anaesthetist
• Check biopsies and forms
• Check /weigh removed tissues
• Check instruments and swabs
• Check documentation
• Transfer patient to recovery
• Reset operating room
Nurse’s Main Responsibilities
in Postoperative Phase
• Ensure a patent airway
• Help maintain adequate circulation
• Prevent or assist with the treatment of
shock
• Maintain proper position and function of
drain tubes and IV infusion
• Monitor for potential complications
Postoperative
I. Immediate postoperative period
II. Later postoperative period
III. Preparation for transfer or
discharge
Immediate postoperative
period.
• Airway patency
• Effectiveness of respiration
• Presence of artificial airways
• Mechanical ventilation, or supplemental oxygen
• Circulatory status, vital signs
• Wound condition, including dressings and drains
• Fluid balance, including IV fluids, output from catheters
and drains and ability to void
• Level of consciousness and pain
Later postoperative period
• Respiratory function
• General condition
• Vital signs
• Cardiovascular function
• Fluid status
• Pain level
• Bowel and urinary elimination
• Dressings, tubes, drains, and IV lines
Preparation for transfer or
discharge • Monitor healing
• Monitor mobility
• Assess condition
• Meet with family
• Check home situation
• Check information for community care
• Check medication etc to take with them
• Check transport processes for transfer/
discharge
Future for perioperative nursing
• It will be faster paced and more complex.
• It will be much more linked to technology
• Team work and communication will be critical.
• The culture of the Operating Room will change
to give nurses a lead role
• Perioperative nurses will
monitor and lead on patient
safety and risk
management issues.
The future
• Increased recognition of expertise
• Increased ability to do minor surgery
• Today in some countries advanced
practitioners can take additional training and:
– Can make own admission checks
– Can order all necessary tests including blood tests
– UK prostate biopsies – one practitioner 2- 400 per
year
– Australia – vasectomies, athroscopies
in Future: Different knowledge
and skills needed • In addition to current knowledge and
competencies other information and skills
will be needed including:
– An understanding of informatics & software
management
– physics
– Radiology
– nanotechnology
– technology management
New trends – Dr Hamlin
in Sydney identified
• Perioperative Nurse Practitioner (in
Australia and Canada)
• Surgical Care Practitioner(SCP) and
Perioperative Specialist Practitioner (PSP)
in UK.
• Perioperative Nurse Surgeon’s Assistant
(PNSA) in rural Australia. It is similar to:
• Registered Nurse First Assistant (RNFA)
in Canada and USA
Advanced roles
• Nurse Anesthetist (in USA)
• Nurse sedationist (in Australia)
• Nurse endoscopist (in UK and
just beginning in Australia)
• Surgical nurse liaison roles
Other evolving roles
• Outside the operating
room setting. The day
surgery role is now very
well defined.
• advanced roles in pre-
anaesthetic and pre-
surgical clinics assessing,
screening and including
patient and family
education
Thank you