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Key Topics
- Requirement
- Solution
- 1.0. Introduction
- 2.0. Factors influencing the safety
- 3.0. Apply the quality and safety framework to perioperative practice
- 4.0. Perioperative nursing interventions in the preoperative, intraoperative and post-operative phases
- 5.0. Capabilities of professionals
- 6.0. Communication
- 7.0. Critical thinking
- 8.0. Self-management
- 9.0. Conclusions
- References
Requirement
Question: Perioperative care: Factors influencing the care and possible strategies for the enhancement of perioperative care
Solution
1.0. Introduction
The use of surgical procedures for the mitigation of diseases has tremendous but an unrecognized impact on health sciences. Among 33 million patients who were undergoing for surgery in the United States, about 1 million patients reported adverse events leading to an estimated cost of $25 billion annually (Christopher, 2009). However, the complications in terms of adverse events are expected to be increase with age of the population and across the world. The complications associated with cardiovascular system are one of the most common perioperative adverse events in patients undergoing noncardiac surgery. Certain instances can also lead to mortality (Fecho et al., 2008). Therefore it is essential for clinicians to be acquainted with current heart hazard assessment and preventive strategies for patients undergoing noncardiac surgery. In addition, the risk of complications shall be assessed prior surgery. Similarly, the pulmonary complications shall be evaluated proactively to estimate the probability of occurrence of complications during or after the surgical procedures. Therefore it is desired to know the risk associated with perioperative complications for the patients who are undergoing for surgical procedures. A collaborative work among the health workforce is desired to be in place in the healthcare system to minimize the risk and occurrence of complications. Among the health workforce, the nursing professionals are close in monitoring the patient health status. Therefore, they shall communicate on time-to-time basis to the remaining and responsible persons of facility. In view of the teamwork, the present paper describes the challenges and strategies of teamwork for the preoperative management of patients with surgical procedures.
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2.0. Factors influencing the safety
Health care services are provided to patients in an environment with complex interactions among numerous components, for example, the infection procedure itself, clinicians, innovation, arrangements, techniques, and assets. At the point when these perplexing elements associate, destructive and unforeseen results (e.g., mistakes) can happen. Human blunder has been characterized as a failure of a scheduled activity or a succession of mental or physical actions to be completed as intended, or the use of a wrong plan to achieve an outcome (Hughes, 2008). More patient and health workforce related factors exist in perioperative cases. This could be either lack of adequate co-operation among the staff (Davenport et al., 2005). Diverse teams are involving in the perioperative management including respiratory team who pay attention towards the vital parameters such as breathing rate. Irrespective of the work level the team should extend the services i.e., no discrimination should exist among the staff. The healthcare professionals from diverse groups are responsible for perioperative management including attending physicians, a nurse practitioner, a case manager, a dietitian, a pharmacist, a social worker, registered respiratory therapists, and a nursing staff (Tsai et al., 2013).
3.0. Apply the quality and safety framework to perioperative practice
The safety framework for health care offers a safe and high quality care to the periopertaive patients. The framework comprises of three major principles (i) care is consumer centred, (ii) driven by information, and (iii) organized for safety (Safety and high quality, 2010). The framework provides a basis for strategic and operational safety and quality plans. It also designs the goals for health service improvement be used as a guide for looking into speculations and examination in wellbeing and quality advance talk with buyers, clinicians, administrators, analysts and policy investigators about how they may best form partnerships to improve safety and quality. The consumer centred approach eases the patients to get when they need it. Making sure that healthcare staff respect and respond to patient decisions, needs and values. Shaping associations between patients, their family, carers and healthcare providers. The second approach, driven by information utilizes the up-to-date knowledge and evidences to guide decisions about care. Safety and quality data are collected, analyzed and fed back for improvement. The third strategy, organized for safety means making safety a central feature of how healthcare facilities are run, how staff work and how funding is organized.
4.0. Perioperative nursing interventions in the preoperative, intraoperative and post-operative phases
The perioperative care team comprises of surgeon, anesthesian and nurse. The team is responsible for anesthetic aspects and support the team responsible for surgical procedures. In case of issues, can provide the clarifications (Fuji et al., 2013). The need for surgical intervention is determined during the initial surgical evaluation. The anesthesia evaluation establishes anesthesia assessment and risk stratification for care across the perioperative environment. Additional support is desired for the maintenance of anesthesia. The calculated doses of anesthetic should be adequate to prevent the short or long term of anesthesia and avoid adverse events. This is the area where the preoperative team has to be co-operated and co-ordinate with surgical team in ensuring the anesthesia. The health workforce should also assess the vital parameters during surgery and take necessary precautions to see the vital parameters within the normal window. After the surgical technique, the intraoperative consideration group normally gives the post anesthesia care group with a report of the procedures that happened amid the surgical method. The post anesthesia nursing care group starts the patient care to the postsurgical nursing group who typically administers to patients on surgical consideration units and at plans the patients for the move to home or to another ward. The preoperative appraisal is one of the basic purposes of administer to patients transitioning into the perioperative environment. A great part of the perioperative wellbeing literature by and large addresses the communications of failure in the postoperative hand over (Nagpal et al., 2010). Conversely, one study by Nagpal et al (2010) focuses to susceptibilities in the preoperative stage and confirmed that or colleagues had shifting measures of learning of the patient and as it were 27% of the total patient medical information was known to all the primary team members in the OR (i.e, surgeon, anesthesiologist, surgical assistants, scrub person, RN circulator) (Nagpal et al., 2010a)
5.0. Capabilities of professionals
The nursing and the health workforce skills should be improved. A periodical check up for the skills shall be measured. In addition, an improvement in communication skills and collaboration between and within departments can further ensure the decrease of adverse events at perioperative phases. Diverse components are reported for a successful teamwork (O’Daniel & Rosenstein, 2008). The components include, open communication, no punitive environment, clear course, clear and known parts and errands for colleagues, comfortable work environment, shared duty regarding group achievement, proper equalization of part investment for the undertaking, affirmation and preparing of contention. Clear details with respect to power and responsibility, clear and known basic leadership systems, customary and routine correspondence and data sharing, empowering environment, including access to required assets and instrument to assess results and modify appropriately. The joint effort in medicinal services is characterized as human services experts expecting correlative parts and agreeably cooperating, sharing duty regarding critical thinking and settling on choices to figure and do plans for patient consideration
6.0. Communication
Wellbeing experts tend to work autonomously, despite the fact that they may talk about being a part of a group. Endeavors to enhance health care safety and quality are regularly imperiled by the correspondence and joint effort hindrances that exist between clinical staff. Albeit each association is unique, the barriers to effective communication that organizations face have some common themes. The barriers that influence, personal values and expectations, differences, hierarchy, troublesome conduct, society and ethnicity, generational contrasts, chronicled bury proficient and intra proficient contentions, contrasts in language, contrasts in working schedules and expert schedules, fluctuating levels of arrangement, capabilities, and status, contrasts in prerequisites, directions, and standards of expert instruction, fears of weakened proficient character, contrasts in responsibility, pay system and awards, concerns in regards to clinical obligation, multifaceted nature of consideration and accentuation on fast decision-making. Most of the barriers manifest between nurses and physicians despite of periodic interactions. In all interactions, cultural differences can exacerbate communication problems E.g., in a few societies, people abstain from being emphatic or testing assessments straightforwardly. The staff who witness poor execution in their companions might be reluctant to talk up as a result of apprehension of striking back or the feeling that talking up won't benefit any. Connections between the people providing patient care can have a powerful influence on how and even if important information is communicated. Therefore the skills of communication in terms of oral and writing have to be improved.
7.0. Critical thinking
Many, including major accrediting agencies and health care administrators, consider critical thinking for nurses. The thinking of the health work force should be in depth pre-, during and post-operative phases. Multiple drugs are in general administered to patients to prepare them for surgeries. Certain drugs are so sensitive to induce adverse events if the doses exceed the threshold levels. However it depends on the physiology and pathological states of the patient. Therefore the nursing professional as they are in close proximity to the patient’s should be aware of the pharmacology of drugs. In case of certain adverse events, they should think in depth why the event has occurred and be able to handle the situation. The critical thinking influences the open mindedness i.e., open mindedness decreases with critical thinking. The skills may be related to organizational culture, geography, and/or specialization (Fesler-Birch, 2010). Hence the decrease soft skill towards collaboration further affect the team work and thus patient safety. In view of these constraints, the management has to conduct periodic training programs and assessment reviews for the identification of limitations of nurses and to organize the training programs
8.0. Self-management
Always the support and presence of physician at work place is not expected to the patients who undergo for surgical procedures. The nurses should work independently in some of the instances, should be able to take decisions on their own in emergency situations. The nurses should manage the work and complete them in stipulated time. The systematic work culture can possible with experience, learnings and implementation of new methods. Therefore, the self-management-based interventions can lead to improved health outcomes in people with perioperative instances and multiple patient characteristics are associated with the development of self-management behaviors. Low health literacy has been implicated in poorer self-management behaviors and increased costs to health services (Mackey et al., 2016). The hospital management while recruiting the nurses for surgical departments should pay attention for the highly qualified nurses. The management also should evaluate their performance and enhance the skills if required.
9.0. Conclusions
The aspects of perioperative care is discussed. It appears diverse healthcare professionals are involving in the surgical operations. Therefore adequate communication among the nurses and between the professionals is needed to increase the collaboration and thus team work. Always team work can minimize the adverse events and show a positive outcome. Such practices can significantly improves the quality and safety of patients. The positive patient outcomes depends on teamwork and a collaborative work environment. To assure a quality care, furthermore, advance a society of wellbeing, medicinal services associations must address problems that threaten the performance of the health care team.
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O’Daniel, M & Rosenstein, AH (2008) Professional communication and team collaboration. In: Hughes, R.G, editor. Patient safety and quality: An evidence-based handbook for nurses. Rockville (MD): Agency for healthcare research and quality (US); Chapter 33. Available from: http://www.ncbi.nlm.nih.gov/books/NBK2637/
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Fecho, K., Lunney, A. T., Boysen, P. G., Rock, P., & Norfleet, E. A. (2008). Postoperative mortality after inpatient surgery: Incidence and risk factors.Therapeutics and Clinical Risk Management, 4(4), 681–688.
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Hughes, R.G (2008) Nurses at the “Sharp End” of Patient Care. In: Hughes, R.G., editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 2. Available from: http://www.ncbi.nlm.nih.gov/books/NBK2672/
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Davenport, D. L., Henderson, W. G., Khuri, S. F., & Mentzer, R. M. (2005). Preoperative Risk Factors and Surgical Complexity Are More Predictive of Costs Than Postoperative Complications: A Case Study Using the National Surgical Quality Improvement Program (NSQIP) Database. Annals of Surgery,242(4), 463–471. http://doi.org/10.1097/01.sla.0000183348.15117.ab
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Tsai, M.J., Huang, J.Y., Wei, P.J., Wang, C.Y., Yang, C.J., Wang, T.H & Hwang, J.J (2013) Outcomes of the patients in the respiratory care center are not associated with the seniority of the caring resident. Kaohsiung J Med Sci. 29(1), 43-9
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Fuji, K.T., Abbott, A.A & Norris, J.F (2013) Exploring care transitions from patient, caregiver, and health-care provider perspectives. Clin Nurs Res. 22(3), 258-74
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Nagpal, K., Vats, A., Ahmed, K., Smith, A.B., Sevdalis, N., Jonannsson, H., Vincent, C & Moorthy, K (2010) A systematic quantitative assessment of risks associated with poor communication in surgical care. Arch Surg. 2010 Jun; 145(6):582-8.
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Nagpal, K., Vats, A., Ahmed, K., Vincent, C & Moorthy, K (2010a) An evaluation of information transfer through the continuum of surgical care: a feasibility study. Ann Surg. 252(2), 402-7.
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Fesler-Birch, D.M. (2010) Perioperative nurses' ability to think critically. Qual Manag Health Care. 19(2), 137-46. doi: 10.1097/QMH.0b013e3181dafec7.
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Mackey, L.M., Doody, C., Werner, E.L & Fullen, B. (2016) Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have? Med Decis Making. 36(6), 741-59.
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Christopher, M.W (Jan-2009). Perioperative evaluation. Retrieved from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/preventive-medicine/perioperative-evaluation/
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Safety and high quality (Dec-2010) Australian Safety and Quality Framework for Health Care. Retrieved from http://www.safetyandquality.gov.au/wp-content/uploads/2012/04/Australian-SandQ-Framework1.pdf
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