Impeccable nursing care is an essential contribution to the successful outcome of a patient scheduled to undergo a surgical procedure. An efficient preoperative nursing assessment includes that of the patient’s state of mind. Most patients are understandably nervous or anxious prior to surgery, however, significantly high levels of anxiety may have a negative effect on the surgical procedure and/or expected outcomes.
“Preoperative anxiety may be an anticipatory response to an experience viewed by the patient as a threat to his or her customary role in life, permanent incapacity, body integrity, increased responsibilities or burden on family members, or life itself” (Smeltzer, Bare, Hinkle, Cheever, 2010, p. 433). Because preoperative anxiety can have such an impact on the scheduled procedure, proper nursing intervention is imperative.
The nurse should be empathetic with the patient and encourage him or her to voice any questions or concerns they may have about the procedure or expected outcomes. It may be necessary to repeat instructions or clarify more than once because of the patient’s difficulty focusing on what’s being said due to elevated anxiety levels. There are several techniques the nurse may utilize in an attempt to alleviate preoperative anxiety. If the nurse should choose to utilize imagery, he or she would have the patient picture and focus on peaceful scenery.
Patients without much of an imagination may need assistance creating such a scene in their head as well as staying in that “happy place”, for those patients the nurse should use guided imagery where he or she will remain close by and guide the patient through his or her imaginary paradise. Optimistic self-recitation is another technique that may be used and I’m convinced that the best example of such is The Little Engine That Could. This technique attempts to increase “positive energy” in the patient and provide them with a more optimistic outlook on the procedure and expected outcomes.
Other techniques include music therapy and good old-fashioned distraction. Some patients may even find comfort in their spiritual beliefs and it has been noted that “spiritual beliefs can be as therapeutic as medication” (Smeltzer et al. , 2010, p. 434). In addition to psychologically preparing the patient for surgery, the nurse is also responsible for physically preparing the patient for the procedure. The list of preoperative precautions and preparations is extensive and includes: Ensure that identification, blood, and allergy bands are correct, legible and secure… …Reinforce & clarify teaching.
Remove nail polish and makeup to facilitate circulatory assessment during and after surgery. Remove hair pins and jewelry. A ring may be protected and secured with tape to the finger if client is unable or unwilling to remove it… …Insert an indwelling catheter, intravenous line or nasogastric tube as ordered. Remove dentures, artificial eye, and corrective lenses and store them in a safe, labeled container and location. Leave a hearing aid in place if the client cannot hear without it, and notify the operating room nurse… …Administer preoperative medication as scheduled.
Ensure safety after medication administration by placing the client on bed rest with the side rails up and the call light within reach… …Provide ongoing supportive care to the client and family. Complete the preoperative surgical checklist. Document all preoperative care in the appropriate location. Verify the client’s identity and surgical sight with the surgical personnel (Burke, Mohn-Brown, Eby, 2010, p. 208). There are, in fact, several different types of nurses that work together to make each surgical procedure a success and a positive experience for the patient.
Two types of nurses with intraoperative responsibilities include the circulating nurse and the scrub nurse. The circulating nurse acts as the patient advocate in the operating room, therefore, all the responsibilities of said nurse revolve around patient safety. The circulating nurse verifies consent, coordinates movement of the surgical team in the operating room, ensures aseptic practices are being adhered to and continually assesses the patient for possible complications and intervenes accordingly (Smeltzer, Bare, Hinkle, Cheever, 2008).
The responsibilities of the scrub nurse are to assist the surgeon and surgical assistants through anticipating what they will need next and handing over the surgical equipment as necessary. The scrub nurse is the only team member in the operating room permitted to come in contact with sterile materials and supplies and is even responsible for setting up the sterile fields for such supplies because he or she performs a surgical scrub just as the surgeon and surgical assistants do.
As the surgical incision is closed, the scrub nurse and circulating nurse then work together as a team and perform counts of sponges and instruments just as they did before the procedure commenced to ensure all materials are accounted for and nothing was left in the patient’s body (Smeltzer et al. , 2008). Although I’ve only detailed the responsibilities of two members of the surgical staff, it is essential that all members work together as a team with the common goal of optimal patient care as priority in order to accomplish expected outcomes successfully.