DJ MS

• Surgery is the branch of medicine that comprises perioperative patient care, including preoperative preparation, intraoperative management, and postoperative care
• Surgery combines physiologic management with an interventional aspect of treatment
• Improvements in perioperative patient care technology are attributed to surgical specialization, sophisticated diagnostic and intraoperative imaging techniques, minimally invasive equipment and technology, ongoing research, and technological advancements
• Learning styles for perioperative learners include visual-spatial, bodily kinesthetic, musical, interpersonal, intrapersonal, linguistic, and logical-mathematical
• The educator is responsible for planning, implementing, and evaluating the learner's experiences in the classroom and clinical perioperative setting
• A structured curriculum uses behavioral objectives, written guidelines, and relevant assignments for feedback to ensure learning has occurred
• Positive reinforcement helps learners build confidence and competence, while disruptive behavior (bullying) is counterproductive
• Learning in the perioperative environment should occur on cognitive, psychomotor, and affective levels
• Expected behaviors of perioperative caregivers include personal attributes, effective communication, teamwork, and clinical competence
• Reality shock sets in as the transition occurs from being a beginning learner to becoming an employed graduate professional nurse or surgical technologist
• Stress management techniques for caregivers include assertive behavior, shared professional communication, humor, listening to the body, mental relaxation, and maintaining control
• Regular sleep, rest periods, exercise, adequate dietary practices, and routine health checkups are essential for maintaining physical health in the perioperative environment
• Mental relaxation techniques such as meditation and mental imagery help caregivers manage stress and support emotional balance
• Orientation is crucial to avoid reality shock for new nurses, especially when unfamiliar with organizational policies and procedures
• Standards of Perioperative Patient Care include:

  • Surgical Conscience
  • Patient Rights
  • Accountability
  • Standardization of Patient Care
  • Recommended Practices
  • Professionalism
  • Professional Perioperative Nursing
  • Evidence-Based Practice
  • Nursing Process
  • Standards of Perioperative Nursing Practice
  • Surgical Technology
  • Clinical Competency of the Surgical Technologist
  • Continual Performance Evaluation and Improvement
• Surgical Conscience:

  • Essential elements of perioperative practice are caring, conscience, discipline, and technique
  • Optimal patient care requires surgical conscience, selflessness, self-discipline, and the application of principles of asepsis and sterile technique
  • Surgical Conscience is a moral obligation to perform duties no matter the cost or consequences
  • Golden Rule: "Do unto the patient as you would have others do unto you"
  • Caregiver should consider each patient as himself/herself or as a loved one
  • Once one develops a surgical conscience, it remains inherent thereafter
• Patient's Rights:

  • Access to health care is recognized as a right of every human being
  • Includes rights to appropriate medical care, informed consent, privacy, information, choice of healthcare provider, self-determination, religious belief, medical records, leave, refusal to participate in medical research, correspondence, expressing grievances, and being informed of rights and obligations as a patient
  • Patient advocacy is essential to provide information, assistance, and support to patients and families during the surgical experience
• Accountability:

  • Means answering to someone for an obligatory action
  • Perioperative nurses and surgical technologists are accountable to patients, employers, educational institutions, profession, self, and other team members
  • Lack of accountability may result in patient injury or dissatisfaction with care
• Standardization of Patient Care Importance:

  • Ensures safety and welfare of patients and personnel
  • Facilitates consistent methods of patient care teaching
  • Consistent procedures provide efficiency and promote high-level proficiency
  • Standards allow intelligent decision-making when modifications are needed
  • Various professional sources provide standards for perioperative patient care
• Professional Sources of Standards:

  • Defined as acts that a reasonably prudent person with comparable training and experience would perform
  • Include standards of care, professional standards, regulatory agency standards, and professional association standards
  • Standards of Perioperative Nursing Practice, Perioperative Administrative Nursing Practice, Perioperative Clinical Practice, Perioperative Professional Practice, Quality and Performance Improvement Standards, and Perioperative Patient Outcomes of Care are essential
• Standards from Regulatory Bodies:

  • Include Federal Medicare Act, Health Insurance Portability and Accountability Act (HIPAA), American National Standards Institute (ANSI) standards, U.S. Food and Drug Administration (FDA) performance standards, Agency for Health Care Research and Quality (AHRQ) clinical practice guidelines, and Occupational Safety and Health Administration (OSHA) standards
• Sources of Standardization Data within Health Care Facility:

  • Facility-specific patient care standards
  • Hospitality policy and procedure manual
  • Safety plan manual
  • Safety data sheets (SDS) or Material Safety Data Sheets (MSDS) describing workplace chemicals and spill procedures
• Safety data sheets (SDS) also known as Material Safety Data Sheets (MDSD) describe chemicals used in the workplace and actions to take when they are spilled into the environment
• Disaster plan manual:

  • Outlines plans for both internal and external disasters
  • Internal disaster is an event that happens within the facility
  • External disaster is an event that happens outside the confines of the facility
  • Combines internal-external disasters such as Hurricane Katrina, which may have multiple stages of resolution
• Infection control manual contains policies and procedures designed to minimize the risk of infection and control the spread of disease within the health care facility
• Perioperative policy and procedure manual contains policies pertaining solely to the administration and operation of the perioperative environment or online in the hospital’s intranet
• Orientation manual is designed to acquaint personnel with the environment policies, and procedures specific to performance and the position descriptions of all personnel
• Instrument book:

  • Lists individual instruments and trays required for each surgical procedure
  • Listed in a central processing computer or in a separate book kept in the instrument processing area
  • Includes photographs and catalog illustrations
  • Contains flash cards and educational textbooks
• Surgeon’s preference cards/case cart sheet:

  • Preference card is maintained in a computerized database or written note for each surgical procedure
• Directories provide an alphabetical listing of the location of supplies and equipment maintained for the instrument room, general workroom, sterile supply room, and general perioperative storage room
• Identifying the patient:

  • Plastic identification wristband is put on the patient when they enter the facility in the admitting area
  • Wristband should be placed in a location that does not interfere with the surgical site
  • Verification of accuracy by asking the patient to state their birthday, spell name, or pronounce name
  • Circulating nurse and anesthesia provider check the wristband with the patient, surgeon, patient’s chart, and surgical schedule
  • Surgeon must visit the patient before administration of anesthesia
• • Identification process can be completed by a parent, legal guardian, or individual with power of attorney
• • Before incision, the entire team pauses for a “time out” as the surgical site is read aloud
  • Allergies or sensitivities are confirmed during the “Time Out” process
  • Availability of correct implants and special equipment is confirmed during the “Time Out” process
• Identifying the surgical site:

  • Surgical site indicated by the consent form should be verified between circulating nurse and patient
  • Universal methods of surgical site verification include asking the patient to describe what they understand of the procedure and to point to or clarify the site if on a particular side of the body
  • Surgeon should mark the site with their initials in indelible ink that does not wash off during intraoperative skin preparation
  • Marking with an X is inappropriate and may be misunderstood
• Professionalism:

  • Professionals act responsibly in accordance with their commitment to public trust and service
  • Requires a combination and coordination of knowledge, skills, and ideals communicated through activities based in higher education
  • Characteristics include defining its own purpose and code of ethics, setting its own standards, conducting its own affairs, engaging in self-evaluation and peer review, and requiring critical thinking skills in clinical judgment, problem-solving, and decision-making
• Liability:

  • Negligence denotes conduct lacking in due care, carelessness, and deviation from the standard of care
  • Malpractice looks at standard care and the professional status of the caregiver
  • 4 D’s of Malpractice: Duty, Deviation, Direct Causation, Damages
  • Examples of nurse breach of duty include failure to assess, failure to communicate, and failure to follow protocols
• Patient confidentiality:

  • The right of an individual to have personal, identifiable medical information kept private
  • HIPAA was enacted in 1996 with 2 main sections: Privacy Rule and Security Rule
  • Nursing students are required to adhere to HIPAA guidelines from the beginning of providing patient care
• Liability prevention for the facility and team:

  • Become active within professional organizations associated with setting standards for practice
  • Remain current with continuing education, become certified, and maintain credentials
  • Establish positive rapport with patients
  • Comply with legal statutes, standards of accrediting agencies, professional associations, and health care facility policies
  • Adhere to facility policies and procedures
  • Document assessments, interventions, and evaluations of patient care outcomes
  • Prevent injuries by adhering to policies and procedures
• • Maintain good communication with other team members
• Liability issuances:

  • Borrowed Servant Rule indicates that an employer may be held liable for the actions of a temporary employee
  • Independent Contractor rule implies that the employer may be held responsible for employees under the master-servant rule
  • Reasonable Man Theory is a legal standard used to determine negligence
  • Doctrine of Res Ipsa Loquitur allows the patient’s injury to stand as an inference of negligence under certain conditions
  • Doctrine of Respondeat Superior holds an employer liable for an employee’s negligent conduct