Surgical nursing

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A surgical nurse, also referred to as a theatre nurse or scrub nurse, specializes in perioperative care, providing care to patients before, during and after surgery. To become a theatre nurse, Registered Nurses or Enrolled Nurses must complete extra training. Theatre nurses can focus on different speciality areas, depending on which they are interested in.

Contents

There are many different phases during surgery where the theatre nurse is needed to support and assist the patient, surgeons, surgical technicians, nurse anaesthetists and nurse practitioners. Pre-operative, the nurse must help to prepare the patient and operating room for the surgery. During the surgery, they assist the anaesthetist and surgeons when they are needed. The last phase is post-operative, ensuring that the patients are provided with suitable care and treatments.

People who want to become surgical nurses attend nursing school and specialize in surgical nursing. They are often required to pass examinations administered by the government or by nursing certification boards before being allowed to work as nurses, and they may also be expected to attend periodic continuing education classes so that they keep up with developments in the nursing field.[ citation needed ]

In the UK and Australia, surgical patients (those who have undergone a minor or major surgical procedure) are nursed on different wards from medical patients. Nursing practice on surgical wards differs from that of medical wards.

Surgical nurses may practice in different types of surgery:

Surgical nurses are responsible for approximately six patients, depending on the nature of the surgical ward. Intensive Care and High-Dependency units usually have one to two nurses per patient.

Duties

Theatre nurses are part of the perioperative surgical team; they work alongside surgeons, surgical technician, nurse anaesthetists and nurse practitioners.

In surgery there are three main phases: preoperative, intraoperative and postoperative. These phases collectively are known as the perioperative period. Each phase is related to specific activities carried out and skills needed for different stages of nursing. [1]

Preoperative Phase

This stage is undertaken when the patient decides to have surgery. [1] It may include discussing with the patients all the benefits of the procedure but also the dangers that could occur. This is an opportunity for the patient to discuss any concerns they may have. Also the theatre nurses must make sure that the patients are in good condition, before going ahead with the surgery. While it is very important to prepare a patient physically, it is also important to mentally prepare a patient prior to surgery. [2] A surgical nurse will help prepare the patient using various methods often including family members depending on the situation. [2] The patient will normally express any concerns about the surgery to the nurse; this information will be passed on to other hospital staff including the surgeon. The appropriate actions will be taken dependent on the situation.[ clarification needed ] [2]

Intraoperative Phase

This stage begins when the ward nurse, who has prepared the patient for surgery, delivers the patient and their notes to the theatre and/or anaesthetic nurse. Many checks are undertaken at this stage to ensure a safe environment for the patient and the theatre staff. The theatre nurse works to maintain a sterile environment and to ensure the surgical equipment is working well. The nurse also organises all surgical instruments and ensures all supplies needed during the surgery are available.

Postoperative Phase

This phase begins when the theatre/anaesthetic nurse delivers the patient's notes to the nurses and staff in the Post-Anaesthetic Care Unit (PACU). This can also be known as the recovery room. Here the nurse's immediate attention is on checking the patient's airway and breathing. In this phase nurses also attend to pain relief and any other complications following surgery. These nurses, often in day surgery cases, attend to provide patients and their caregivers with support and instructions and requirements needed for home care. [1]

The first twenty-four hours post surgery are critical, and many procedures are required to monitor the patient. Observations of the patient need to be taken and recorded every fifteen minutes. General observations include heart rate, blood pressure, temperature, respiratory rate and oxygen saturation. [3] Further post-operative tasks for a surgical nurse include: urine output, assessment of wound sites, replacing intravenous requirements and reporting any abnormalities. [3] To aid recovery, It may be necessary for the nurse to be free of the world

Credentials

To become a surgical nurse, CCTC one must have undertaken appropriate training, and be registered with the state nursing board (Nursing and Midwifery Council, UK; An Bord Altranais, Rep. of Ireland). In Australia, both Registered Nurses and Enrolled Nurses work in surgical wards. Registered nursing received their training over a longer period of time, as they receive a university degree. To become a registered nurse you must complete a bachelor's degree of nursing which takes up to 3 years. Enrolled Nurses complete a Diploma of Nursing which is a full-time course over 12 –16 months at Technical and Further Education (TAFE). [4]

In Australia, the education standards are nationwide, requiring an undergraduate nursing degree and graduate diploma in perioperative nursing. The undergraduate degree has a full-time study duration of three years at the University of Notre Dame. [5] The post graduate diploma in preoperative nursing has some prerequisites including; undergraduate nursing degree, be a full-time employee of the Fremantle Health Service, hold a current licence to practice as a level one registered nurse and have at least one year of postgraduate experience. [6] With these qualifications it is possible to become a surgical nurse in Australia.

The Graduate Diploma in Perioperative Nursing is available 1 year full-time or equivalent part-time and is developed to qualify the registered nurse to enhance knowledge and combine skills to work as a specialist within the perioperative field. [7]

Types of surgical nurse

In the theatre room there are two main types of nurses: a scrub nurse and a circulation nurse. The scrub nurse must make sure they are familiar with and well educated about every piece of operational equipment; as on request they are required to provide the surgeons with the equipment needed. The scrub nurse is also responsible for making sure all operating equipment is accounted for before and after the operation.

The scrub nurse is responsible for many important technical duties. These can include ensuring they have correctly prepared the surgical instruments and trolleys and ensuring that all operating supplies have been sterilised. Non-technical skills are also important for the scrub nurse role. These can include cognitive skills such as formulating appropriate decisions.[ clarification needed ] Another non-technical skill required is being able to work well within a team, for example, the ability to communicate well with the surgical team during a procedure. [8]

Surgical instruments on a trolley in preparation for surgery. Surgical Instruments 01.jpg
Surgical instruments on a trolley in preparation for surgery.

A circulation nurse has many similar responsibilities; they should ensure that the operating room is clear and uncontaminated by previous surgeries or other infections. They are also there to collect, open, clear and sterilise packets containing surgical equipment. [10]

Surgical Nurse Interaction with Patients

It is important for surgical nurses to have a thorough understanding of their roles and interactions with patients and their immediate families within a surgical care environment. One vital role for a surgical nurse is to provide support and confidence to their patient while they are in hospital. Nurses are also required to possess good communication skills and maintain a professional relationship with their patient. It is important for the nurse to build a trusting relationship with their patient but this can prove difficult within the short time available. Due to the fast-paced surgical surroundings, there is little time for surgical nurses to provide information and reassurance before and after surgery. Many patients feel vulnerable and anxious prior to their surgical procedure and it is important for the surgical nurse to recognise their patient's need for psychological support. It is therefore important for the surgical nurse to understand their role in relation to the patient. By understanding the emotional needs of their patients, surgical nurses’ perspectives and conduct towards their patient will influence the patient's experience. [11]

Preoperative Teaching

Preoperative teaching if delivered competently is an important aspect of patient care. Positive effects of preoperative teaching include a reduction in patients’ anxiety levels, healing time, complications post- surgery, pain relief usage and an increase in satisfied and co-operative patient's in regard to their procedure and treatment. Preoperative teaching is essential to a patient's understanding of the surgical procedure and to help them prepare for postoperative healing. [12]

Preoperative teaching is usually undertaken before the day of surgery. This can be delivered by verbal and/or written instructions. Patients may also have an appointment scheduled with the perioperative nurse to talk over any concerns regarding the procedure. Teaching is further discussed on the day of surgery and also before the patient is discharged to leave the hospital. [13]

Potential Careers

Nurses who work in the operating theatre become specialists in the field or a specific sub speciality. Once you find a specialist field or specific sub speciality you enjoy working in, the nurse will commence as a junior nurse. After gaining a large amount of knowledge and skills set with experience, if the nurse chooses to become more of an expert in this field, the theatre nurse may do a postgraduate certificate or diploma to become a Clinical Nurse for that speciality. The salary for a surgical nurse in Australia can range from $47,721 to $80,160 with an average of $57,103 this data was recorded in March 2016. [14]

Professional Associations - Perioperative Nursing Associations

The role of professional associations is to protect, increase and promote common interests of their members. They provide opportunities such as networking, clinical education and research grants. Each Australian State has their own group which form a subdivision of ACORN (Australian College of Perioperative Nurses). Western Australia's group is the Operating Nurses Association of Western Australia (ORNA). Both ACORN and ORNA have a website which provides information about their organisation. These websites are: www.acorn.org.au and ornawa.org [15]

Related Research Articles

<span class="mw-page-title-main">Surgery</span> Medical procedures that involve incisive or invasive instruments into body cavities

Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions, to alter bodily functions, to reconstruct or improve aesthetics and appearance, or to remove unwanted tissues or foreign bodies. The subject receiving the surgery is typically a person, but can also be a non-human animal.

<span class="mw-page-title-main">Anesthesia</span> State of medically-controlled temporary loss of sensation or awareness

Anesthesia or anaesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia, paralysis, amnesia, and unconsciousness. An individual under the effects of anesthetic drugs is referred to as being anesthetized.

<span class="mw-page-title-main">Podiatrist</span> Medical professional devoted to the medical treatment of disorders of the foot

A podiatrist is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for all practitioners of podiatric medicine. The word chiropodist was previously used in the United States, but it is now regarded as antiquated.

<span class="mw-page-title-main">Operating theater</span> A room in a hospital in which surgeries are performed

An operating theater is a facility within a hospital where surgical operations are carried out in an aseptic environment.

<span class="mw-page-title-main">General anaesthesia</span> Medically induced loss of consciousness

General anaesthesia (UK) or general anesthesia (US) is a method of medically inducing loss of consciousness that renders a patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general anaesthetic medications, which often act in combination with an analgesic and neuromuscular blocking agent. Spontaneous ventilation is often inadequate during the procedure and intervention is often necessary to protect the airway. General anaesthesia is generally performed in an operating theater to allow surgical procedures that would otherwise be intolerably painful for a patient, or in an intensive care unit or emergency department to facilitate endotracheal intubation and mechanical ventilation in critically ill patients. Depending on the procedure, general anaesthesia may be optional or required. Regardless of whether a patient may prefer to be unconscious or not, certain pain stimuli could result in involuntary responses from the patient that may make an operation extremely difficult. Thus, for many procedures, general anaesthesia is required from a practical perspective.

<span class="mw-page-title-main">Anesthesiology</span> Medical specialty concerned with anesthesia and perioperative care

Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician specialized in anesthesiology is called an anesthesiologist, anaesthesiologist, or anaesthetist, depending on the country. In some countries, the terms are synonymous, while in other countries, they refer to different positions and anesthetist is only used for non-physicians, such as nurse anesthetists.

<span class="mw-page-title-main">Nurse anesthetist</span> Nurse trained to provide anesthesia care

A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. Nurse anesthetists (NA's) administer or participate in administration of anesthesia services in 107 countries, working with or without anesthesiologists. Because of different historical backgrounds, anesthetist responsibilities and roles vary widely between countries. Depending on the locality, their role may be limited to intraoperative care during anesthesia itself or may also extend before and after. The International Federation of Nurse Anesthetists was established in 1989 as a forum for developing standards of education, practice, and a code of ethics.

Perioperative mortality has been defined as any death, regardless of cause, occurring within 30 days after surgery in or out of the hospital. Globally, 4.2 million people are estimated to die within 30 days of surgery each year. An important consideration in the decision to perform any surgical procedure is to weigh the benefits against the risks. Anesthesiologists and surgeons employ various methods in assessing whether a patient is in optimal condition from a medical standpoint prior to undertaking surgery, and various statistical tools are available. ASA score is the most well known of these.

<span class="mw-page-title-main">Surgical technologist</span> Profession

A surgical technologist, also called a scrub, scrub tech, surgical technician, or operating department practitioner or operating room technician, is an allied health professional working as a part of the team delivering surgical care. Surgical technologists are members of the surgical team. The members of the team include the surgeon, surgeon's assistant, circulator nurse and anesthesia provider. They possess knowledge and skills in sterile and aseptic techniques. There are few mandatory professional requirements for surgical technologists, and the scope of practice varies widely across countries and jurisdictions. Surgical technologists attend junior colleges and technical schools, and many are trained in military schools. In the military they perform the duties of both the circulator and the scrub. The goal is for surgical technologists to be able to anticipate the next move the surgeon is going to make in order to make the procedure as smooth and efficient as possible. They do this by having knowledge of hundreds of surgical procedures and the steps the surgeon needs to take in order to complete the procedure, including the very wide range of surgical instruments they may need. Specialties can include, but are not limited to, the following: genitourinary, obstetrics and gynaecology, urology, ENT, plastics, general, orthopedics, neurology, and cardiovascular. They only work in surgical or perioperative areas and are highly specialized. Surgical technologist is the proper term for a two-year program which earns a degree in applied sciences. The profession is up and coming and highly in demand.

<span class="mw-page-title-main">Royal College of Surgeons of Edinburgh</span> Medical Royal College

The Royal College of Surgeons of Edinburgh (RCSEd) is a professional organisation of surgeons. The RCSEd has six faculties, covering a broad spectrum of surgical, dental, and other medical and healthcare specialities. Its main campus is located on Nicolson Street, Edinburgh, centred around the 18th century Surgeons' Hall. The campus includes Surgeons' Hall Museums, a medical and surgical library, a skills laboratory, a symposium hall, administrative offices and a hotel. A second UK office was opened in Birmingham in 2014 and an international office opened in Kuala Lumpur, Malaysia, in 2018.

The perioperative period is the period of a patient's surgical procedure. It commonly includes ward admission, anesthesia, surgery, and recovery. Perioperative may refer to the three phases of surgery: preoperative, intraoperative, and postoperative, though it is a term most often used for the first and third of these only - a term which is often specifically utilized to imply 'around' the time of the surgery. The primary concern of perioperative care is to provide better conditions for patients before an operation and after an operation.

In the United Kingdom, operating department practitioners (ODPs) are allied healthcare professionals who are involved in the planning and delivery of perioperative care. As the name suggests, they are primarily employed in surgical operating departments, but they may also work directly within a variety of acute clinical settings, including pre-hospital emergency care, emergency departments, intensive care units (ICUs), endoscopy suites, interventional radiology, cardiac catheter suites, obstetric theatres and reproductive medicine.

<span class="mw-page-title-main">Operating room management</span>

Operating room management is the science of how to run an operating room suite. Operational operating room management focuses on maximizing operational efficiency at the facility, i.e. to maximize the number of surgical cases that can be done on a given day while minimizing the required resources and related costs. For example, what is the number of required anaesthetists or the scrub nurses that are needed next week to accommodate the expected workload or how can we minimize the cost of drugs used in the Operating Room? Strategic operating room management deals with long-term decision-making. For example, is it profitable to add two additional rooms to the existing facility? Typically, operating room management in profit-oriented health-care systems emphasizes strategic thinking whereas in countries with publicly funded health care, the focus is on operational decisions.

Cardiothoracic anesthesiology is a subspeciality of the medical practice of anesthesiology, devoted to the preoperative, intraoperative, and postoperative care of adult and pediatric patients undergoing cardiothoracic surgery and related invasive procedures.

<span class="mw-page-title-main">Scrubs (clothing)</span> Lightweight, washable clothing worn by hospital staff or other medical personnel

Scrubs, or sometimes Surgical Scrubs, or Nursing Scrubs, are the sanitary clothing worn by physicians, nurses, dentists and other workers involved in patient care. Originally designed for use by surgeons and other operating room personnel, who would put them on when sterilizing themselves, or "scrubbing in", before surgery, they are now worn by many hospital personnel.

Perianesthesia nursing is a nursing specialty practice area concerned with providing nursing care to patients undergoing or recovering from anesthesia. Perianesthesia nursing encompasses several subspecialty practice areas and represents a diverse number of practice environments and skill sets.

Perioperative nursing is a nursing specialty that works with patients who are having operative or other invasive procedures. Perioperative nurses work closely with surgeons, anaesthesiologists, nurse anaesthetists, surgical technologists, and nurse practitioners. They perform preoperative, intraoperative, and postoperative care primarily in the operating theatre.

<span class="mw-page-title-main">Veterinary medicine in the United Kingdom</span> British legal framework for the practice of animal medicine

Veterinary medicine in the United Kingdom is the performance of veterinary medicine by licensed professionals. It is strictly regulated by the statute law, notably the Veterinary Surgeons Act 1966. Veterinary medicine is led by veterinary physicians, termed "veterinary surgeons", normally referred to as "vets".

An autotransfusionist, also known as a perioperative blood management technologist, is a specialized allied health professional who operates the cell saver machine during surgeries that expect significant blood loss.

Eye injuries during general anaesthesia are reasonably common if care is not taken to prevent them.

References

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