Look at perioperative nursing from a historical perspective and critically analyze the past, present and future of this specialty clinical area and outline through discussion the changes in both the perioperative environment and the role of the nurse in this area
The nursing practice is driven by the needs of patients and their family members, the needs of health care systems and the needs of society. Today’s greatest challenge nurses face is envisioning and delivering high-quality nursing care while continuously decreasing the cost of delivering care. In perioperative nursing, the roles of the perioperative nurse practitioner and the perioperative clinical nurse specialist (CNS) have developed to provide sound future-oriented leadership, expert clinical knowledge and skills, and individualized patient-centered care to specific patient populations
The older practice of medicine was empirical, though theories were formed to suit the visible results. Physiology was in the beginning stages, and chemistry was hardly known, the natural cause of diseased action had not been observed. With the advancement of the first two, and correct observations of the nature, cause, phenomena, and duration of certain diseases, certain principles which now form a very good guide to a rational practice have been evolved.in past ages the perioperative environment was crude, hand washing and boiling of instruments were not known. Then came the recognition of the importance of hand washing, gradually clothes, instruments, and dressing were thoroughly cleaned. Practices of sterilization came in as they were developed. Rubber gloves were introduced in 1891 and later the face mask followed. Nurses had minor duties like administering anesthesia, sutured and tied, placed drains and removed dead and devitalized tissue.in following years nursed roles increased to instrument nurses, x-ray department to surgery prep and later on when professionalism came in students were exposed to the practice of perioperative nursing.as the responsibilities of the operating room nurse expanded to include care in the preoperative and postoperative periods, the term perioperative was recognized as more appropriate. The preoperative phase is the period that is used to physically and psychologically prepare the patient for surgery. The length of the preoperative period varies. For the patient whose surgery is elective, the period may be lengthy. For the patient whose surgery is urgent the period is brief. Diagnostic studies and medical regimens are initiated in the preoperative period. Information obtained from preoperative assessment and interview is used to prepare a plan of care for the patient. Nursing activities in the preoperative phase are directed toward patient support, teaching and preparation for procedure .perioperative nursing have changed over the years since its conception, with advancements in technology and practices. There are some big changes in the nursing field in the last 50 years such as uniform, salaries, job demand, the roles of nurses, the different roles for men and women nurses. Today’s operating room nurses have a different role than what they did in the past. They have a new name (perioperative nurses) to encompass all three phases of surgery (the pre-, intra-, and postoperative stages). They provide, manage, teach and study the care of patients undergoing surgery or other invasive procedures
Nursing courses are a lot more intense and harder than it was 10 years ago. Over the last 10 years, there has been a gradual shift for the education and training of nurses. Currently, all nurses have to be trained to a degree university level before they can practice as a fully qualified nurse currently compared to the past, there is a lot more technology for nurses to use and to be trained to use. Nurses today have to keep up to date with a lot more technology than a nurse 50 years would have had to. Technology can be seen as a good and bad gadget, because not only do nurses have to provide basic and skilled care, they also have to learn how to work with many types of equipment that are specific to their area of expertise. The most popular equipment used every day by a nurse is a computer. Nurses use them every day as a way to document the care given to a patient. Although new technology is a good advantage for health care, it has its flaws, for example, training the staff to use it costs a lot of money, but on the other hand, it can save lives. Other important equipment used every day that benefits patients are the air mattresses as they help to prevent deep vein thrombosis (DVT’s) and assistance with IV insertion which has made things a lot simpler. All of the new high tech equipment being simplified is for user- friendliness, which means that the new methods are speeding things up. Infection control plays a big part in the National Health Service (NHS) every day, so new technology is being developed all the time, although the basic hand washing procedures remain very much the same.
Major complications in surgery affect up to 16% of surgical procedures. Over the past 50 years, many patients’ safety initiatives have attempted to reduce such complications. Since the formation of the National Patient Safety Agency in 2001, there have been major advances in patient safety. Most recently, the production and implementation of the Surgical Safety Checklist by the World Health Organization (WHO), a checklist ensuring that certain mistakes (wrong-site surgery, wrong operation etc.) do not occur, irrespective of healthcare allowance
Recently, the concept of Enhanced Recovery After Surgery (ERAS) programs have developed. These aim to speed recovery by using a combination of proper pre-surgery optimization, perioperative measures, and postoperative planning to ensure early mobilization, oral intake of fluid, and ambulation. Such programs have been used widely in colorectal and orthopedic surgery, demonstrating a significant reduction in morbidity, hospital stay, and required intravenous fluid for colorectal surgical patients
In 2011, National Institute for Health and Clinical Excellence (NICE) created a group looking into the use of monitoring systems to allow assessment of the depth of anesthesia. These systems use assessment of brain electrical activity whilst under anesthesia to try and establish how deeply anesthetized the patient is. The group recently published their guidance stating that use of the monitors was associated with lower general anesthetic consumption and shorter recovery times potentially a useful tool for those on enhanced recovery after surgery (ERAS). A further recent technological advance has been that of noninvasive blood flow monitoring such as oesophageal Doppler monitors. These have the capacity to demonstrate changes in central circulation without a need for intervention, such as placement of a central venous catheter, thereby reducing the length of stay and postoperative complications, whilst allowing high-quality monitoring perioperatively.
The perioperative period is a very dangerous time for patients; half of all adverse events in hospitals are related to surgical procedures in the operating department. Improvements in anesthetic and surgical practice have resulted in a significant reduction in complications.
The role of the nurse in the perioperative environment has been widened and advanced in ways that include providing emotional support to the patient prior to the induction of anesthesia which was not considered in the past as training was not diversified to such fields. Nurses also implement and enforce policies and procedures that contribute to patient safety, not as the old era where nurses only passed tools used in the operating room or did the sterilization of equipment and clothes. With the development of technology in the perioperative environment, there are advantages such as the improvement of patient safety and care which was not the case in the past where environments were less sterile and equipment limited. Advancements in technology have lessened the amount of time in procedures that were time-consuming by enabling on/off-site skills building and increased proficiency. Some advancements have taken up the nurses role and have been termed as “dehumanized patient care, “thus solving cases of shortage of nurses and is a cost saving investment for healthcare facilities. Workflow for nurses has been made faster and easier compared to the past where it was slower and more complicated. Data is entered once with real time decision support provided by the live feed in the clinical area that is shared with other experts in the medical field. This is enabled by high levels of surgical equipment and software application interoperability throughout the perioperative process. All data generated by clinical equipment should flow into clinical databases without manual re-entry, thus increasing clinical acceptance and accuracy of data by reducing user workload and transcription errors.
Communication is important in the modern medical practice, both with patients and with fellow healthcare professionals. Miscommunication is the key factor in medical errors. Given the complex inter-professional environment in theatres, it should come as no surprise that communication impacts on roughly 65% (i.e. reportable) events. This is crucial in the perioperative environment, where up to half of all complications are potentially avoidable. Given the prominent role communication plays in errors, methods for improving communication between team members have advanced thus the reduction of the frequency of such errors.
Conclusion
As training, in technical and non-technical skills improve for perioperative nurses, the patient benefit should increase. Anesthetists have a long history of patient safety orientated practice, while a 0.7% decrease in mortality seems small when one considers the volume of operations performed worldwide its importance becomes clear. Early implementation of such measures in the development of health systems is critical to reducing mortality burden currently associated with surgery.
. The combination of incident and clinician training should be improved for guideline formation and use for patients benefit. Getting as much information out of a bad situation and trying to adapt practice to ensure it never happens again. Greater provision of nontechnical skills training and use of simulation for the practice of drills in anesthetic crisis resource management (CRM) settings would allow for optimization of such non-technical skills.
practice makes perfect, the use of non-technical skills is no exception. With time, communication, drills, checklists, and people’s skills will be refined and patient safety improved. all patients are put at risk during an operation, the whole basis of modern anesthetic practice is to minimize this risk while optimizing patient outcome. Use of the world health organization surgical safety checklist(WHO SSC), improved communication, understanding of human factors and non-technical skills development.these been crucial steps in this ongoing battle. The whole patient journey must be considered and carefully mapped if patients are to have their surgery and recover as safe as possible
Perioperative nursing roles continue to change as time goes by. There is the need for continuing strong leadership skills, expert clinical skills, creative management, ongoing education, and research in every department of surgical services. The perioperative nurse specializes in addressing these roles. Great opportunities exist within the field of nursing for perioperative nurses to expand their practice using their creativity, ideas, and skills. Using the clinical nurse specialist in the perioperative setting can foster creativity, stimulate the development of new methods based on research, and maximize the delivery of high-quality care by the entire operating room staff.
