CARE OF THE SURGICAL PATIENT

Posted: January 5th, 2023

CARE OF THE SURGICAL PATIENT

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Care of the Surgical Patient

Introduction

Surgery is a critical medical procedure that requires substantial care and attention to ensure that the patient walks out of the process safe and sound. The paper my care for a surgical patient plan that encourages those in charge of the operation to be careful when caring for such patients to give the most desirable outcome. It reminds readers of the argument by Nestler (2019, 1) that appropriate patient outcomes is exceedingly essential and should be the chief treatment objective of hospitals. A suitable way I would care for a surgical patient in the operating room is to follow a Checklist developed by WHO to guide surgical procedures with the goal of promoting patient safety. Other than caring for the patient while undergoing the operation, I find it critical to give the necessary care and attention once the person leaves theater. The study also elaborates on my need to observe ethical guidelines when caring for surgical patients because this ensures that I act in the right and acceptable manner that satisfies all parties into the operation.

Using the WHO Checklist

Effective care of a surgical patient requires different teams to come together towards helping the patient regain better health as soon as possible. Practitioners such as anaesthesia professionals, surgeons, technicians, and other operating room groups engaged in surgery need to identify the most suitable approach for offering care to surgical patients (Vickers, 2011, 502). Much like a pilot requires team members to successfully steer the aircraft, a surgeon plays critical functions in the operation process but cannot achieve the desired outcomes without collaborating with others (World Health Organization, 2021). A team destined to give the most appealing care for a surgical patient should comprise of everyone involved, each of whom serves a role in promoting the success and safety of an operation and the care one receives after the procedure.

In addition to forming a robust team that will offer the necessary care throughout the surgical process, I acknowledge that it is vital to adhere to a suitable care plan that would ensure the patient undergoes procedure while exposed to minimum harm. A suitable guide I would employ in this instance is the World Health Organization (WHO) Surgical Safety Checklist that was developed in 2008 with the objective of enhancing the safety of those undergoing surgery (World Health Organization, 2021). The guide came after the formation of the Safe Surgery Saves Lives program that was formed by the World Alliance for Patient Safety as an attempt by WHO to minimize the number of fatalities occurring from surgical practices globally. The objective of the venture is to promote clinical will and political pledge to touch on the need to uphold safety, as well as inadequate anesthetic care measures, insufficient and inappropriate communication among caregivers, and avoidable surgical contamination (World Health Organization, 2021). The identified issues have proved to be rampant, severe, and preventable concerns in all settings and nations. To help operating teams in minimizing the emergence of these incidences, the World Alliance for Patient Safety – in collaboration with patients around the globe, patient safety experts, surgeons, nurses, and anaesthesiologists – has recognized a set of safety measures that could be carried out in any surgical room. The objective of the resulting Checklist is to promote enhanced collaboration and communication between teams offering surgical procedure and care (World Health Organization, 2021). It is imperative to understand that the regulatory is not a component or element of official policy; instead, it serves as a tool for utilization by clinicians aiming at enhancing the safety and outcomes of their activities and lowering inappropriate surgical mortalities and complications.

The WHO Checklist serves as the most suitable guide for me to completing the assignment and for offering guidance in real-life practice because it offers suggestions taking into account that different settings will embrace their own approaches. Each guideline is included depending on expert or clinical evidence that its inclusion will minimize the likelihood of preventable surgical adversities and that adherence to is not likely to cause injury or unbearable costs (World Health Organization, 2021). The Checklist is a suitable guide for me because it is created for preciseness and simplicity. Many of the suggested guidelines are already used as regular practices in health institutions across the globe, though they are hardly adhered to as recommended by WHO (World Health Organization, 2021). Each member of the surgical team, therefore, should examine and practice with the manual and know how to adequately and effectively incorporate these critical safety and care measures into normal workflow of the operation and care.

The foremost objective of WHO’s Checklist is to help make sure that I unremittingly follow to a few safety stages and thus decrease the most widespread and preventable threats jeopardizing the well-being and lives of those who undergo surgery. An appropriate way to ensure implementation of the Checklist when offering care to a surgical patient is to mandate a single person with the duty of checking boxes in a list that the team can create to ensure it focuses on all areas (World Health Organization, 2021). A checklist coordinator can take the responsibility for checking the boxes, but any other health professional or clinician participating in the care of the surgical patient can play the function.

Offering an effective care to a surgical patient requires me to focus on the three phases that the Checklist identifies as being crucial at the different times of the procedure. The first phase is the period prior to the induction or provision of anaesthesia, commonly referred to as the Sign In stage (World Health Organization, 2021). The second stage is the time after induction and prior to the surgical procedure or the Time Out phase, and during and immediately after closing the wound but before removing the patient out of the theater, also called the Sign Out phase. In each category, the Checklist I ensure that the coordinator confirms that the group has completed its roles and responsibilities before moving to the next step (World Health Organization, 2021). Adequately and properly incorporating the Checklist into my practice allows me to achieve heightened efficiency and reduce disruptions, while aiming to fulfil the steps appropriately.

Sing In

Before providing an anaesthesia, I will verbally engage with the patient whenever possible to verify his or her identity. I also ensure whether the procedures guiding the operation are properly outlined and that the site is identified, and also whether the location for the procedure is clearly set out (World Health Organization, 2021). In addition, I ensure that the consent is available to proceed with the surgery. Working with a coordinator confirms that the pulse oximeter does not have any deficiency. Also working with an anaesthesia specialist ensures that the patient is not is not at the risk of experiencing severe complications that worsen their condition (World Health Organization, 2021). Typically, the team overseeing the surgery will be available for sign in, as the practitioners may not be available for sign in, as the lead doctor in them operation may have a clearer perception of projected allergies, blood loss, or other factors complicating things for the patients.

Time Out

For the Time Out phase, I confirm that each member in the mitigation process introduces themselves by their name and roles. I verify that the team poses for some moment before commencing the operation to ensure that it conducts the right procedure to the correct person, and that they are in the right site (World Health Organization, 2021). I make sure the team verbally converses with each other and assess their critical features of their plans and for the procedure utilizing the Checklist elements for direction (World Health Organization, 2021). I make sure the patient gets antibiotics in the right time and conduct all other relevant imaging to acquire as much data as possible that would me to transit to the next level.  

Sign Out

For the Sign Out phase, I will engage other team members and take count of all components used in the procedure as well as mark all specimens. I will identify any issues or equipment problems that should be addressed (World Health Organization, 2021). Eventually, I will review the main issues and plans regarding postoperative the recovery process and management before shifting a person to the theater room.  

I comprehend that assigning a single individual the duty of the checklist process is central for the accomplishment of the whole process. In the intricate setting of a theater, any of the procedures may be overlooked during the hurried pre, intra, or postoperative procedures. Assigning one person to verify the completion of each stage of the checklist can ensure that safety measures are not left out in the rush to proceed with the next level of the operation (World Health Organization, 2021). I will work closely with the coordinator to guide the rest of the team of what is required of them until is competent enough to take part in the care process. The main merit of putting the duty of marking the checklist on one person is that an antagonistic connection may be formed with other members of the operating team. The coordinator’s responsibility is to prevent the team from moving to the next level of the procedure until each step is adequately mitigated, but in doing their work may irritate or leave out other members of the team (World Health Organization, 2021). Thus, I will carefully take into consideration which member of staff is adequately placed to serve the role. As identified, for most facilities a circulating nurse will play the role, although any practitioner can take the responsibility.

Care Outside the Operating Room

I believe that the care a surgical patient receives should extend to outside the operating room to adequately ensure that they get over the condition quite effectively. Usually a patient must spend some time at the wards after undergoing surgery to allow medical practitioners to assess their progress. I in this scenario performs postoperative nursing care by constantly monitoring the vital signs such as heart rate (pulse), blood pressure, body temperature, and respiratory rate (breathing rate) usually marked as RR or BP (Macron and Dexter, 2006, 89). Nevertheless, depending on the patient’s condition, I may have to take other measurements, which could either be the fifth or sixth vital sign (Macron and Dexter, 2006, 90). I must ensure that the patient is free from complications in order to move from the post-anesthesia care unit to their home or clinical unit (Macron and Dexter, 2006, 90). Nevertheless, the probability for developing problems moves beyond the immediate postoperative care and continuous nursing valuation is required in the postoperative nursing practice as well.

An effective postoperative care requires me to pay attention to three crucial phases. Phase one is immediately the patient leaves the operation room also called post-anesthesia period where the patient requires one-on-one attention and care. I at this stage monitors muscle strength, blood pressure, consciousness, heart or cardiac rhythm, and any respiratory complications (Macron and Dexter, 2006, 93). The second phase is continued recovery when the consciousness of the patient returns to normal and the patient’s renal, cardiac, and pulmonary functions stabilize (Macron and Dexter, 2006, 93). The second phase seeks to help the patient to transit to wellness in the most suitable manner. I in the third phase should continuously monitor the patient to ensure they completely get over the effects of the anesthesia and are able to care for themselves. A vital tool that may aid postoperative care is Enhanced Recovery after Surgery (ERAS) that Aasa, Hovback and Bertero (2013, 1607) term as a standardized multimodal caring plan utilized within colorectal surgery. The model advocates for engagement of all stakeholders, responsibility, security, and a feeling of trust when caring for the patient. Otherwise, the care process may not yield the anticipated results if I do not indulge other all stakeholders.

Care for Patients who undergo Bypass Surgery

Additional care is needed to effectively care for patients who undergo coronary bypass surgery, a procedure that seeks to improve blood flow to the heart. The primary intention of the procedure is to alter the flow of blood flowing around the area of a blocked artery in the heart. Patients who undergo this kind of specialized surgery require equally special care and attention to achieve the best results and quick recovery (Kulik, Ruel, and Jneid 2015, 132). Soon after leaving the hospital, I ensure that someone stays with the patient at home for about the first one or two weeks after the surgical procedure (Kulik, Ruel, and Jneid 2015, 132). I make sure that the patient does not stand for unnecessarily longer period, particularly on the same position. I engage the patient in regular walking because this helps the heart and lungs to restore their operations effectively after the medical procedure (Kulik, Ruel, and Jneid 2015, 136). Climbing is a good exercise for those who have undergone bypass surgery, but it is essential to be keener because such patients have problems with maintain balance for longer. Such a patient should not engage in active house chores such as folding clothes and setting the table for meals or after eating. I advise those who have undergone bypass surgery to halt or desist from any activity when they feel pain or become dizzy because this could aggravate the condition. Nevertheless, I recommend further medical intervention if the patient faints, develops persistent cough, gains unexplained weight, develops relentless headache, or if the wound produces secretions or is opened or damaged in any way (Kulik, Ruel, and Jneid 2015, 137). The same attention is needed when offering care to a patient who undergoes abdominal surgery because failure to offer quality surgical nursing care to such patients could aggravate their condition (Fatkulina, Souminen, and Razbadauskas, 2011, 245). Disregarding such forms of care exposes patients who have undergone surgery to significant threats that may require more time, resources, commitment, and perseverance to overcome.

The Need to Observe Ethical Theories

I while caring for surgical patients observe the ethical theories that guide health care practices to achieve the best outcome. Being conversant with the different theories can have various advantages, which have the capacity to inform and impact the care of patients, discard or refute inappropriate practices and lead service providers to be become better informed about areas of ethical disagreement. Brodin, Hellzen, and Haggstrom (2017, 1087) advocate for the need to observe ethical guidelines when in the operating theatre (OT), especially when using local or regional anaesthesia that allows the patient to be conscious during the operation. In addition, ethical theories offer part of the decision-making basis because the theories depict the viewpoints from which team members seek guideline as they make resolutions (Varkey, 2021, 20). Besides, ethics serve the basis of values which vary from one culture or community to another. Applying medical ethics provides a suitable opportunity to examine a particular health issue, often a clinical problem, and using logic and facts to decide what the most appropriate course of action. It is essential to follow ethical guidelines because practitioners may experience a number of disturbing of confusing ethical issues even in a small medical practice or matter (Varkey, 2021, 22). Some of the common issues that adhering to ethical theories may help to address when caring for a surgical patient, including restricting treatment to achieve an organization’s budget or due to insurance regulations, accepting money to proceed with care, engaging in romantic affairs with the patient or members of the family, and covering a blunder (Varkey, 2021, 22). Furthermore, following ethical theories present a better chance to avoid violating patient confidentiality, or making decisions based on individual perceptions.

I will apply the four basic ethical components or guidelines to decide issues they encounter while attending to the patient. The first is the need to observe autonomy whereby I acknowledge that patients primarily have the right to influence their own health practice (Varkey, 2021, 25). Thus, I seek the patient’s views and opinions in handling some matters to avoid taking actions that could contradict the patient’s interests and desires. I while attending to the surgical patient observe the ethical principle of justice, which entails distributing the gains and complexities of care across the community or society (Varkey, 2021, 25). I do not disregard the patient based on their color, religion, education status, gender, political affiliation, or socioeconomic status, and instead regard everyone as being equal and deserving equal attention. The group attending to a surgical patient should practice beneficence as an ethical guide because this offers an opportunity to do good for the patient. It ensures that the patient overcome the condition without much harm or psychological discomfort (Varkey, 2021, 25). More fundamentally, I observe the ethical guideline of nonmalfeasance, which guides practitioners not to harm the patient.

Nevertheless, ethical values are not restricted to the four principles alone. There are other key guidelines to consider, such as being transparent and accountable, being truthful, being respectful, and showing reverence for other people’s values. Besides, medical ethics is not just a simple process. It requires one to use skills, such as collecting the facts required to make a choice and presenting the decision in a manner than convinces or all other parties (Varkey, 2021, 26). I ensure that the team attending to the surgical patient practices listening skills as an essential aspect of medical ethics. Often, ethical disagreements emanate from not being conversant will all facts, or not offering all the necessary information to the patient (Varkey, 2021, 26). In addition, health workers who can express their ethical concerns and utilize effective negotiation skills may have a chance to transform organizational procedures and policies that do not advocate for effective care of surgical patients or any other client receiving care at the facility.

Several other factors prompt me to take medical ethics seriously when offering care to a surgical patient. Effective application of medical ethics presents a good chance to address the disputes between physicians, patients, family, or other stakeholders (Varkey, 2021, 26). It is essential to acknowledge that the participating parties are most likely acting based on their emotions, which make it hard to arrive at a fair and logical decision without considering ethical guidelines. Referring to ethical values presents a better chance to maintain a positive conscience bearing in mind that all health practitioners want to do the right thing at the right time (Varkey, 2021, 27). I acknowledge at this point that being an ethical service provider is more essential than seeing as many clients as possible or making money. Another reason why I need to observe ethical guidelines is to avoid looking uninformed, especially in the way I may make uninformed decisions because they either did not bother to consider ethical guidelines or did not comprehend what their role requires of them.

I increase my likelihood of adhering to ethical when I follow the phases of ethical decision-making. I must be conversant with the problem, which entails knowing the nature of ethical concern and the circumstances surrounding it. I proceed to gather the necessary information regarding how to handle such ethical situations (Varkey, 2021, 27). I at this stage may refer to ethical codes, health manuals, position papers, declaratory statement, and recorded evidence based practices. I review the collected data to understand the possible cause of the problem, and to know what mitigation approach is likely to yield the best results (Varkey, 2021, 27). I then proceed to select the most suitable option and use it to address the ethical concern. Finally, I review the intervention and find out if it leads towards the targeted objectives.

Conclusion

The study identifies the need to follow the WHO Surgical Safety Checklist when I offer care to a surgical patient to achieve the best results. The model requires me to focus on the key areas of the three phases that caregivers must follow keenly to achieve the best outcome. The process requires the patient to give their approval and to ascent to the place and procedure conducted on him or her. The coordinator plays a vital role in ensuring that all needed equipment are in place before the operation commences. It is also essential to verify at this phase whether the patient has any form of allergy, airway problem, or is at risk of losing blood. I while handling the second phase (Time Out) ensure team members introduce themselves, communicate verbally, anticipate critical occurrences, and ensure timely admission of antibiotic prophylaxis. The Sign Out phase is a critical stage where I record the process, take count of instruments, label necessary specimen, and review the entire procedure. In addition to following the recommended steps for offering care at the surgical room, I consider measures that would ensure the patient continues to enjoy the services that would help him or her get out of the situation more effectively. The plan informs about the need to ensure that those who undergo bypass surgery engage in the right activities while at home to avoid exposing themselves to serious threats that could affect their recovery and possibly their wellbeing. I monitor the activities of such people, and ensure that they do not engage in activities that require them to strain or use a lot of effort. I follow the guidelines of medical health theories that give direction on what way to act when offering care to achieve the best results. I chiefly observe basic ethical principles such as autonomy, justice, beneficence, and nonmalfeasance as well as other ethical values that ensure the caregivers act in the most appropriate manner throughout the care process. I understand that I am in a better place to apply the ethical guidelines in my daily practice by following the recommended steps of the ethical decision-making process that requires adequate awareness on the nature of the problem before finding the most effective solution.

Reference List

Aasa, A. Hovback, M. and Bertero, C. (2013) The importance of preoperative information for patient participation in colorectal surgery care. Journal of Clinical Nursing, 22(11-12) 1604-1612.

Brodin, K. Hellzen, O. and Haggstrom, M. (2017). Intraoperative care of the conscious patient from the perspective of the operating theatre nurse: A grounded theory. Open Journal of Nursing, 7, 1086-1099.

Fatkulina, N. Souminen, T. and Razbadauskas, A. (2011) Research on the quality of abdominal surgical nursing care: A scoping review. Medicine, 47(5) 245-256.

Kulik, A. Ruel, M. and Jneid, H. (2015) Secondary prevention after coronary artery bypass graft surgery: A scientific statement from the American Heart Association. Circulation, 131(10) 927-964.

Macron, E. and Dexter, F. (2006) Impact of surgical sequencing on post anesthesia care unit staffing. Health Care Management Science, 9(1) 87-98.

Nestler, N. (2019) Nursing care and outcomes in surgical patients – why do we have to care? Innovative Surgical Sciences, 4(4), 1-6.

Varkey, B. (2021) Principles of clinical ethics and their application to practice. Medical Principles and Practice, (30) 17-28.

Vickers, R. (2011). Five steps to safer surgery. Annals, 93(7) 501-503.

World Health Organization (2021) Implementation manual surgical safety checklist. Available from: https://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Manual_finalJun08.pdf [accessed 25 June 2021].