Perioperative and Perianesthesia Nursing
The special field known as perioperative and perianesthesia nurs-ing includes a wide variety of nursing functions associated with the patient’s surgical experience during the perioperative period. Perioperative and perianesthesia nursing addresses the nursingroles relevant to the three phases of the surgical experience: preoperative, intraoperative, and postoperative. As shown inChart 18-1, each phase begins and ends at a particular point in the sequence of events that constitutes the surgical experience, and each includes a wide range of activities the nurse performs using the nursing process and based on the standards of practice (American Society of PeriAnesthesia Nurses, 2000; Litwack, 1999; Quinn, 1999).
The preoperative phase begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room table. The scope of nursing activities during this time can include establishing a baseline eval-uation of the patient before the day of surgery by carrying out a preoperative interview (which includes not only a physical but also an emotional assessment, previous anesthetic history, and identification of known allergies or genetic problems that may affect the surgical outcome), ensuring that necessary tests have been or will be performed (preadmission testing), arranging appro-priate consultative services, and providing preparatory education about recovery from anesthesia and postoperative care. On the day of surgery, patient teaching is reviewed, the patient’s identity and the surgical site are verified, informed consent is confirmed, and an intravenous infusion is started. If the patient is going home the same day, the availability of safe transport and the presence of an accompanying responsible adult is verified. Depending on when the preadmission evaluation and testing were done, the nursing activities on the day of surgery may be as basic as performing or updating the preoperative patient assessment and addressing ques-tions the patient or family may have.
The intraoperative phase begins when the patient is trans-ferred onto the operating room table and ends when he or she is admitted to the postanesthesia care unit (PACU).
In this phase, the scope of nursing activity can include providing for the patient’s safety, maintaining an aseptic environment, en-suring proper function of equipment, providing the surgeon with specific instruments and supplies for the surgical field, and completing appropriate documentation. In some instan-ces, the nursing activities can encompass providing emotional support by holding the patient’s hand during general anesthe-sia induction, assisting in positioning the patient on the oper-ating room table using basic principles of body alignment, or acting as scrub nurse, circulating nurse, or registered nurse first assistant (RNFA).
The postoperative phase begins with the admission of the pa-tient to the PACU and ends with a follow-up evaluation in the clinical setting or at home. The scope of nursing care covers a wide range of activities during this period. In the immediate post-operative phase, the focus includes maintaining the patient’s air-way, monitoring vital signs, assessing the effects of the anesthetic agents, assessing the patient for complications, and providing comfort and pain relief. Nursing activities then focus on pro-moting the patient’s recovery and initiating the teaching, follow-up care, and referrals essential for recovery and rehabilitation after discharge. Each phase is reviewed in more detail later.
Historically, the perioperative nurse’s practice environment has been isolated, consisting of the area behind the double doors of the surgical suite. Although the nursing process guided nursing care, the fundamentals of assessment, diagnosis, planning, intervention, and evaluation were often misunderstood by practitioners un-familiar with the delivery of surgical care. In recent years, the ac-ceptance of a conceptual model for patient care, published by the Association of PeriOperative Registered Nurses, formerly known as the Association of Operating Room Nurses (still abbreviated AORN), has helped to delineate the relationship of various com-ponents of nursing practice and the effect on patient outcomes (Beyea, 2000). The Perioperative Nursing Data Set (PNDS) is a language that describes the practice of perioperative nursing prac-tice in four domains: safety, physiologic responses, behavioral re-sponses, and health care systems (Fig. 18-1). The first three domains reflect phenomena of concern to perioperative nurses and are composed of nursing diagnoses, interventions, and out-comes that surgical patients and their families experience. The fourth domain, the health care system, comprises structural data elements and focuses on clinical processes and outcomes. The model is used to depict the relationship of nursing process com-ponents to the achievement of optimal patient outcomes.
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