Preoperative Nursing Management
Surgery, whether elective or emergent, is a stressful, complexevent. Today, as a result of advances in surgical techniques and instrumentation as well as in anesthesia, many surgical procedures that were once performed in an inpatient setting now take place in an ambulatory or outpatient setting. Approximately 60% of elective surgeries are now performed in an ambulatory or out-patient setting (Russell, Williams & Bulstrode, 2000). This trend has increased the acuity and complexity of surgical patients and procedures. The number of surgical patients admitted for overnight hospital stays is expected to continue to decrease.
In the past, the patient scheduled for elective surgery would be admitted to the hospital at least 1 day before surgery for eval-uation and preparation; these activities are now completed before the patient is admitted to the hospital. Today, many patients ar-rive at the hospital the morning of surgery and go home after recovering in the postanesthesia care unit (PACU) from the anes-thesia. Often, surgical patients who require hospital stays are trauma patients, acutely ill patients, patients undergoing major surgery, patients who require emergency surgery, and patients with a concurrent medical disorder. Although each setting offers its own unique advantages for the delivery of patient care, all re-quire a comprehensive preoperative nursing assessment and nurs-ing intervention to prepare the patient and family before surgery.
Today’s technology has led to more complex procedures, more complicated microsurgical and laser technology, more sophisti-cated bypass equipment, increased use of laparoscopic surgery, and more sensitive monitoring devices. Surgery might now in-volve the transplantation of multiple human organs, the implan-tation of mechanical devices, the reattachment of body parts, and the use of robots and minimally invasive procedures in the oper-ating room (Mack, 2002). Advances in anesthesia have kept pace with these surgical technologies. More sophisticated monitoring and new pharmacologic agents, such as short-acting anesthetics and more effective antiemetics, have improved postoperative pain management, reduced postoperative nausea and vomiting, and shortened procedure and recovery times.
Concurrent with technologic advances have been changes in the delivery of and payment for health care. Pressure to reduce hospital stays and contain costs has resulted in patients under-going diagnostic preadmission testing (PAT) and preoperative preparation before admission to the hospital. Many facilities have a presurgical services department to facilitate testing and to initi-ate the nursing assessment process, which may focus on patient demographics, health history, and other information pertinent to the surgical procedure. The increasing use of ambulatory orsame-day surgery means that patients leave the hospital sooner,which increases the need for teaching, discharge planning, prepa-ration for self-care, and referral for home care and rehabilitation services. Competent care of ambulatory or same-day surgical pa-tients requires a sound knowledge of all aspects of perioperative and perianesthesia nursing practice.