© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION CHAPTER 1 Introduction to Perioperative Nursing LEARNER OBJECTIVES 1. Define the three phases of the surgical experience. 2. Describe the scope of perioperative nursing practice. 3. Identify members of the surgical team. 4. Discuss application of the Perioperative Nursing Data Set (PNDS). 5. Discuss the outcomes a patient can be expected to achieve following a surgical intervention. 6. Describe the roles of surgical team members. 7. Describe the responsibilities of the perioperative nurse in the circulating role. LESSON OUTLINE Phases of the Surgical Experience I. Phases of the Surgical Experience 1. The perioperative period begins when the A. Preoperative patient is informed of the need for surgery, B. Intraoperative includes the surgical procedure and recovery, C. Postoperative and continues until the patient resumes his or II. Nursing Process Throughout the Perioperative her usual activities. The surgical experience can Period be segregated into three phases: (1) preopera- A. Assessment tive, (2) intraoperative, and (3) postoperative. B. Nursing Diagnoses The word “perioperative” is used to encom- C. Planning pass all three phases. The perioperative nurse D. Intervention provides nursing care during all three phases. E. Evaluation III. Perioperative Nursing Data Set Preoperative IV. Patient Outcomes: Standards of 2. The preoperative phase begins when the Perioperative Care patient, or someone acting on the patient’s V. Roles of the Perioperative Nurse behalf, is informed of the need for surgery and makes the decision to have the procedure. This VI. Expanded and Advanced Practice Roles phase ends when the patient is transferred to VII. Practice Settings the operating room bed. VIII. Members and Responsibilities of the 3. The preoperative phase is the period that is Surgical Team used to physically and psychologically prepare 1 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION 2 CHAPTER 1 Introduction to Perioperative Nursing the patient for surgery. The length of the pre- For patients who undergo surgery in ambula- operative period varies. For the patient whose tory surgery facilities, day surgery centers, or surgery is elective, the period may be lengthy. office-based surgical settings where the expec- For the patient whose surgery is urgent, the tation is that they will return home on the same period is brief; the patient may have no aware- day they have surgery, it is not uncommon for ness of this period. the perioperative nurse to provide care for the 4. Diagnostic studies and medical regimens are patient during all three phases. initiated in the preoperative period. Informa- 12. Nursing activities in the immediate postopera- tion obtained from preoperative assessment tive phase center on support of the patient’s and interview is used to prepare a plan of care physiologic systems. In the later stages of for the patient. recovery, much of the focus is on reinforcing the 5. Nursing activities in the preoperative phase are essential information that the patient and other directed toward patient support, teaching, and caregivers require in preparation for discharge. preparation for the procedure. Nursing Process Throughout the Intraoperative Perioperative Period 6. The intraoperative phase begins when the patient is transferred to the operating room bed 13. The words “perioperative” and “perioperative and ends with transfer to the postanesthesia nursing” are accepted and utilized in nursing care unit (PACU) or another area where imme- and medical literature. Perioperative nursing diate postsurgical recovery care is given. was formerly referred to as “operating room 7. During the intraoperative period, the patient is nursing,” a term that historically referred to monitored, anesthetized, prepped, and draped, patient care provided in the intraoperative and the procedure is performed. period and administered within the operating room itself. However, as the responsibilities of 8. Nursing activities in the intraoperative period the operating room nurse expanded to include center on patient safety, facilitation of the pro- care in the preoperative and postoperative cedure, prevention of infection, and satisfac- periods, the term “perioperative” was recog- tory physiologic response to anesthesia and nized as more appropriate. In 1999, the orga- surgical intervention. nization that represents perioperative nurses, once known as the Association of Operating Postoperative Room Nurses (AORN), changed its name to 9. The postoperative phase begins with the the Association of peri Operative Registered patient’s transfer to the recovery unit and ends Nurses (AORN). with the resolution of surgical sequelae. The 14. The perioperative nurse is a nurse who special- postoperative period may be either brief or izes in perioperative practice and who provides extensive, and most commonly ends outside nursing care to the surgical patient throughout the facility where the surgery was performed. the continuum of care. The AORN Periop- 10. For patients who will remain in the hospital erative Patient-Focused Model identifies four for an extended stay, the perioperative nurse specific domains—patient safety, physiologic may not provide care beyond patient transfer response, behavioral responses, and the health to the PACU, where postanesthesia care nurses system—that are the areas of concern for the assume responsibility for the patient. In an perioperative nurse. effort to better utilize nursing resources, many 15. The domains of safety, physiologic response, perioperative nurses, particularly in smaller and behavioral responses of patients reflect the hospitals, have been trained in postanesthesia nature of the surgical experience for the patient care and are assuming responsibility for pro- and serve as a guide for providing care. viding care in both the operating room and 16. The fourth domain represents other members of PACU. Care at home, if required, is delivered the healthcare team and the healthcare system. by home healthcare nurses. Perioperative nurses work collaboratively with 11. The majority of operative procedures per- other healthcare team members to formulate formed today are done on an outpatient basis. nursing diagnoses, identify desired outcomes, © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION Nursing Process Throughout the Perioperative Period 3 and provide care within the context of the day of surgery at the surgical facility. Often healthcare system so as to achieve desirable the initial nursing assessment is performed patient outcomes (AORN, 2012a, pp. 3–4). by a nurse who is not a perioperative nurse. 17. Perioperative nurses provide patient care within It is more likely that the perioperative nurse’s the framework of the nursing process. They use assessment of the patient will take place just the tools of patient assessment, care planning, prior to the patient’s entry into the operating intervention, and evaluation of patient outcomes room. This assessment will include a brief inter- to meet the needs of patients who are under- view, a quick physical inspection of the patient, going operative or other invasive procedures. and a review of the patient’s record, including Every patient is unique, and the plan of care the results of diagnostic testing and assessment is tailored to meet the patient’s specific needs. data obtained previously by other caregivers. The plan addresses physiological, psychological, sociocultural, and spiritual aspects of care. Nursing Diagnoses 18. Much of perioperative nursing involves tech- 23. Assessment data provide information that the nical expertise, including responsibility for perioperative nurse uses to formulate nursing equipment, instrumentation, and surgical tech- diagnoses and identify desired outcomes. Several niques. Technical skills and responsibilities are nursing diagnoses, such as knowledge deficit and purposeful within the nursing process during high risk for infection, are typical for the surgical the implementation phase; however, the patient patient. Assessment data form the foundation remains the focus of the perioperative nurse’s for patient-specific nursing diagnoses and plan- activities. ning individualized care tailored to meet each 19. The goal of perioperative nursing is to provide patient’s individual and unique needs. care to patients and support to their families, using the nursing process to assist patients and Planning their families in making decisions and to meet 24. The perioperative nurse uses knowledge of the and support the needs of patients undergoing patient, the proposed procedure, identified surgical or other invasive procedures. The patient needs, related nursing diagnoses, and overall desired outcome is that the patient will desired outcomes to plan care for each patient. achieve a level of wellness equal to or greater than the level prior to surgery. 25. The perioperative nurse begins care planning before the patient is seen, based on knowl- 20. Perioperative nursing care is provided in a edge of the planned procedure, the resources variety of settings, including acute care facili- required, and the common nursing diagnoses ties, ambulatory settings, and physician-based related to surgical intervention. Knowledge office settings. Perioperative nurses provide care to patients, their families, and others who of the individual patient obtained during the support the patient. Three major activities of assessment process is combined with this perioperative nurses