6 Preparation of the patient for surgery
the hospital experience
• To explore the continuity of care from a pre-admission assessment to being admitted for surgery
• To explore the care delivery after admission to hospital and being prepared for the operating theatre
• To determine all the preoperative procedures and protocols required to ensure a safe transfer from ward to anaesthetic room and operating theatre
• To consider the actual and potential problems that patients may experience prior to undergoing surgery
Introduction
Chapter 5 introduced you to what happens prior to patients being admitted for surgery, including pre-admission assessment and identifying what may be required in readiness for their discharge home from hospital. This chapter focuses on what happens when someone actually enters the hospital, undergoes admission to the ward or unit where they are to stay prior to and after surgery and their preparation prior to surgery. For most patients and their families, this can be a very stressful time, and even more so if their admission to hospital has been an emergency.
Care of the patient on admission to hospital
Admission to hospital is part of the ‘perioperative’ period of care (i.e. three phases of preoperative, intraoperative and postoperative) (Pudner 2010). The admission may be planned, with most patients having had a preoperative assessment to ensure specific needs or problems are identified, stress is reduced by information sharing and, in these times, to reduce the risk of a hospital-acquired infection (Pudner 2010:3). Another term for this is ‘elective’ surgery. It may also be an admission for ‘emergency’ surgery which has not been planned.
Read Gilmour’s (2010) explanation in Box 6.1 before considering the nursing care aspect of the preoperative period.
So what role does the nurse play in a planned admission?
Planned admission
Care of the patient within 12 hours of being prepared for surgery
Instructions sent to patients by the hospital inform them of what clothes to bring in and other important information (see Box 6.2 for examples). Knowing this information is helpful during the assessment of a patient on admission to hospital.
Box 6.2 Key patient information for hospital admission for surgery
Pre-arrival
Valuables: patients are advised not to bring valuables or large sums of money if at all possible.
A NHS Choices video explains how patients can prepare for admission to hospital:
http://www.nhs.uk/Video/Pages/Preparingforhospital.aspx (accessed December 2011).
Here are some other approaches linked to care delivery that you may come across in practice or in your reading. Identify their meaning and make some notes. These are often used as part of student assignments involving delivery of patient care (see Appendix 1 at the end of this chapter for brief notes on each):
Appendix 1 Brief meaning of nursing care approaches
1. Named nurse: this term is used mainly in the UK and, according to some authors, has been adopted to mean the same in terms of care delivery as primary nursing has in the USA. The patient is allocated a named nurse on admission to hospital, and Shebini et al (2008) cite the Scottish Office (1992) definition as: ‘A registered nurse, midwife or health visitor who is responsible for assessing, planning, implementing, evaluating and coordinating patient care on an individual basis with a patient or a caseload of patients from admission/transfer/discharge’.
2. Primary nursing: this is a system where the total care of an individual patient and his/her family is the responsibility of one nurse – the primary nurse. They are accountable for the overall care and have the authority to make decisions as the ‘leader’ of the care provided. They are possibly the primary nurse for a small group of patients, delivering individualised and patient-centred care for the whole of their contact with the patient. They are supported by secondary nurses who carry out the care planned by the primary nurse, even when the primary nurse is not available due to off-duty rotas, for example. Some secondary nurses are also primary nurses for their own patients, and decision making and leadership is therefore an integral part of the primary nursing approach to care delivery. The original philosophy of primary nursing is described in a YouTube clip by Professor Marie Manthey (who led a project about the development of this approach and has since become known as the originator of it internationally): http://www.encyclopedia.com/video/kr7t8E5MMoM-primary-nursing-short-story-by.aspx (accessed December 2011).
3. Team nursing: this is a system of providing care as a group of healthcare workers (registered and non-registered) where there is a nominated team leader, normally a qualified nurse. The team leader is responsible for leading the team’s work and also for taking overall responsibility for the planning, delivery and evaluation of the care given. The team leader normally agrees the assignment of care duties with the team and reports directly to the ward manager/sister or person in charge. Team nursing enables development of leadership and management skills, but individual members of the team remain individually accountable and/or responsible for the care they give.
4. Patient allocation: this is a system where each nurse is allocated a small group of patients to deliver care to, usually on a shift-by-shift or day rota basis. It is not as defined as team nursing where the team leader’s role is normally a set one and the team leader’s name is identified on the staff rota list. It allows for an opportunity, in particular, for student nurses to take responsibility for a small group to patients under the guidance and supervision of their mentors, learning not only about the delivery of quality care but also a range of skills such as those adopted by a team leader (e.g. delegation skills, working with others, communication and accountability).
5. Task allocation: this is a very ‘traditional’ method of care delivery and is focused not on the individual patient and their care but on the task required in their care. For example, a member of staff could be allocated to take every patient’s temperature, pulse and respiration, another to take everyone’s blood pressure and another could be tasked with ‘doing the medicines or medicine round’. Task allocation often leads to a hierarchy of tasks and who does them, with less junior staff being delegated those which are considered ‘mundane’ or less important than others.
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