Scope of Plastic Surgery Nursing Practice
Definition of Plastic Surgery Nursing
Plastic surgery nursing specializes in the protection, maintenance, safety, and optimization of health and human bodily restoration and repair before, during, and after plastic surgery cosmetic, reconstructive, and nonsurgical aesthetic procedures. This is accomplished through the nursing process, and includes diagnosis and treatment of human response. The plastic surgery nurse collaborates, consults, and serves as a liaison and advocate for individuals, families, communities, and populations, bridging the role of the plastic surgery nurse with that of other professionals to promote optimal patient outcomes for the whole person.
Foundation of Plastic Surgery Nursing Practice
The specialty of plastic surgery has long pioneered surgical techniques and treatment strategies for human body and facial repair, reconstruction, and replacement in cases of congenital diseases, traumatic injuries, and cancer reconstruction. Plastic surgery sites include the skin, breast, trunk, craniomaxillofacial structures, musculoskeletal system, extremities, and external genitalia. Plastic surgery focuses on the care of complex wounds, replants, grafts, flaps, free tissue transfer, use of implantable materials, and the healing process and response. In addition, cosmetic or aesthetic surgery is an essential component of plastic surgery and is used both to improve overall appearance and to optimize the outcome of reconstructive procedures. (American Board of Plastic Surgery [ABPS], 2011). Plastic surgery interventions encompass all ages, from the neonate to the advanced geriatric healthcare consumer. This requires specialized knowledge and treatment to ensure optimal outcomes.
Plastic surgery is the only specialty recognized and supported by the American Board of Medical Specialties (ABMS, 2000) that provides plastic, reconstructive, and aesthetic surgical procedures through board certification for plastic surgery (www.abms.org).
Plastic surgery is the only specialty recognized and supported by the American Board of Medical Specialties (ABMS, 2000) that provides plastic, reconstructive, and aesthetic surgical procedures through board certification for plastic surgery (www.abms.org).
Media coverage to the general public has deluged our society with information about plastic surgery that is often questionable and confusing. Unfortunately, because of extensive media coverage of plastic surgery and increasing demands for aesthetic plastic surgery, procedures are being performed by other medical specialties without proper preparation, recognition, regulation, board certification, or surgical residency experience. This lack of regulation, specialized knowledge, and skill exposes individuals, families, communities, and populations to unnecessary health and safety risks. Both the increasing awareness in our society (accurate and otherwise) of plastic surgery and the ambiguities of cosmetic surgery call for more nursing, consumer, and provider educational interventions by plastic surgery nurses to help clarify misconceptions. Plastic surgery nurses are aware of the health risks associated with plastic surgery procedures and, as members of the interprofessional healthcare team, complement the plastic surgery specialty by a mutual focus on healthcare consumer safety, health maintenance, and ultimate satisfaction and outcomes.
Plastic surgery nursing practice and standards reflect the nursing process, the nursing standards of both the American Nurses Association (ANA, 2010a) and the Association of periOperative Registered Nurses (AORN) standards of perioperative practice, and AORN standards of nursing practice (AORN, 2011). Plastic surgery nursing requires specialized knowledge and skill levels for both the reconstructive and aesthetic aspects of surgical interventions during the consultation, preoperative, operative, and postoperative stages of the plastic surgery procedure process. Through the implementation and maintenance of specialized plastic surgery nursing standards of practice, individuals seeking or requiring plastic surgery intervention will be provided with education, knowledge, and care to ensure optimal surgical safety, protection, and outcomes.
Development of Plastic Surgery Nursing Practice
Plastic surgery nursing opportunities continue to expand as the demand for plastic surgery procedures and treatments grows, primarily in the United States. According to the American Society of Plastic Surgeons (www.asps.org), more than 17 million plastic surgery procedures and treatments were
performed in 2009, compared to approximately 1.5 million in 1992. The need for knowledge regarding safety, quality, ethical, and procedural issues will increase as plastic surgery becomes more common in a wide range of surgical environments.
performed in 2009, compared to approximately 1.5 million in 1992. The need for knowledge regarding safety, quality, ethical, and procedural issues will increase as plastic surgery becomes more common in a wide range of surgical environments.
Plastic surgery is an interprofessional specialty. The plastic surgeon’s expertise can be utilized by any modality, including but not limited to pediatrics, general surgery, neurosurgery, urology, dermatology, and trauma. Because of the physical and psychological complexities involved in caring for those undergoing plastic surgery, plastic surgery nurses integrate a holistic approach into the plan of care for the plastic surgery healthcare consumer. Plastic surgery nursing skills and knowledge require a strong foundation in the knowledge of pre-, intra-,and postoperative standards and practices; wound healing and wound care; safety and quality; bioethics; psychology; and the application of critical thinking.
In response to the specialized needs of plastic surgery healthcare consumers and the required nursing interventions, 100 surgical nurses convened in 1975 to establish the nonprofit organization called the American Society of Plastic and Reconstructive Surgical Nurses (ASPRSN). In 2001 ASPRSN simplified its name to American Society of Plastic Surgical Nurses (ASPSN). The 100 charter members sought to establish a specialized identity and share the knowledge needed to practice successfully. The mission and philosophy of the ASPSN were founded on principles aimed at improving the quality of nursing care for the healthcare consumer undergoing plastic or reconstructive surgery. The organization is committed to promoting high standards of nursing care and practice through shared knowledge, scientific inquiry, and continuing education, while supporting and encouraging collaborative interaction with clinical practice, administration, research, and academics (www. aspsn.org). The chronology of the development of plastic surgery nursing is summarized below.
Plastic Surgery Nursing: A Chronology
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Today the ASPSN has more than 1,000 active members working in various nursing environments: surgical facilities, home care, nursing research, outpatient care, hospitals, universities, private practice, medical or medi-spas, and others. Members cover a wide range of educational levels, including associate, bachelor’s, master’s, and/or doctorate degrees, and have numerous roles, including advanced practice nurses, nurse first-assistant, and nurse educators. ASPSN serves its members through a national structure of local chapters in the United States and Canada (ASPSN, 2010). Through the development of unique plastic surgery knowledge, the plastic surgery nurse can properly respond to and communicate with a multidisciplinary team assigned to any plastic surgery healthcare consumer.
As the field of plastic surgery evolves and incorporates other medical specialties, the climate for plastic surgery nursing requires continual review
of related trends, products, and procedures. Current statistical data found on the American Society of Plastic Surgeon’s web site (www.asps.org) for 2009, include a 10% increase in breast reconstruction from 2000 to 2009, with tissue expander reconstruction seeing a 12% increase from 2008 to 2009. Breast reduction surgery has increased by 7% from 2000. Tumor removal, including skin cancers, has decreased from 578,161 procedures in 2000 to 487,146 in 2009. Cosmetic surgical procedures have experienced an overall decline since 2000, with a 20% total decrease. Breast augmentation remains the number-one cosmetic procedure, followed by rhinoplasty. With more and more healthcare consumers undergoing bariatric or weight-loss surgical procedures, the number of body contouring procedures (such as buttock lifts, lower body lifts, and thigh and arm lifts) is increasing significantly, and has experienced more than a 50% increase since 2000 (www.asps.org). Minimally invasive procedures have increased 99% since 2000, with Botox showing a 509% increase from 2000; in addition, there has been a significant rise in procedures for dermal fillers and laser resurfacing (www.asps.org). Due to this extraordinary growth, there has been an influx of nurses into this highly challenging arena of plastic surgery practice.
of related trends, products, and procedures. Current statistical data found on the American Society of Plastic Surgeon’s web site (www.asps.org) for 2009, include a 10% increase in breast reconstruction from 2000 to 2009, with tissue expander reconstruction seeing a 12% increase from 2008 to 2009. Breast reduction surgery has increased by 7% from 2000. Tumor removal, including skin cancers, has decreased from 578,161 procedures in 2000 to 487,146 in 2009. Cosmetic surgical procedures have experienced an overall decline since 2000, with a 20% total decrease. Breast augmentation remains the number-one cosmetic procedure, followed by rhinoplasty. With more and more healthcare consumers undergoing bariatric or weight-loss surgical procedures, the number of body contouring procedures (such as buttock lifts, lower body lifts, and thigh and arm lifts) is increasing significantly, and has experienced more than a 50% increase since 2000 (www.asps.org). Minimally invasive procedures have increased 99% since 2000, with Botox showing a 509% increase from 2000; in addition, there has been a significant rise in procedures for dermal fillers and laser resurfacing (www.asps.org). Due to this extraordinary growth, there has been an influx of nurses into this highly challenging arena of plastic surgery practice.
One goal of plastic surgery nursing is to secure the foundation for safety. This is accomplished through stronger regulations, increased education, and awareness among healthcare consumers, families, communities, and populations seeking or requiring plastic surgery-related interventions.
Plastic surgery nurses promote and improve quality of care before, during, and after plastic surgical procedures and treatments to ensure proper health maintenance, safety, and restoration. Plastic surgery nurses determine the specific nursing intervention needed for each individual undergoing a plastic surgical procedure or treatment, in accordance with the nursing process (assessment, diagnosis, outcomes identification, planning, implementation, and evaluation). This nursing specialty continues to develop the knowledge base for evidence-based practice through research into plastic surgery procedures, treatments, and issues.
Healthcare Consumer Population
The plastic surgery nurse interacts with and cares for healthcare consumers who require or desire plastic or reconstructive surgery for enhancement or restoration purposes. The plastic surgery nurse also interacts with wand educates families of plastic surgery healthcare consumers, as well as communities, regarding plastic surgery procedures and issues. The plastic surgery nurse has
the special knowledge and skills needed to meet the needs of the healthcare consumer population. The plastic surgery nurse provides care in a variety of settings, age groups, and populations, including neonatal, pediatric, adult, geriatric, general surgery, neurosurgery, advanced wound management, dermatology, burns, cancer, and trauma healthcare consumers.
the special knowledge and skills needed to meet the needs of the healthcare consumer population. The plastic surgery nurse provides care in a variety of settings, age groups, and populations, including neonatal, pediatric, adult, geriatric, general surgery, neurosurgery, advanced wound management, dermatology, burns, cancer, and trauma healthcare consumers.
Healthcare consumers receiving care and education from a plastic surgery nurse need a thorough understanding of procedures, personal expectations, and mutual goal setting in order to achieve maximum satisfaction and health maintenance. Plastic surgery nurses help healthcare consumers to deal with perceived or altered body image, perceived surgical outcomes, fears, and learning needs associated with a surgical intervention. Healthcare consumers undergoing plastic surgery may encounter psychological, emotional, and physical imbalances during the recovery phase. Managing the psychological discord associated with physical alterations requires specialized knowledge and education.
Reconstructive Plastic Surgery Population
Reconstructive plastic surgery procedures are performed on skin, breast, trunk, craniomaxillofacial structures, musculoskeletal system, extremities, and external genitalia. Nurses in reconstructive plastic surgery require specialized knowledge related to complex wounds, replants, grafts, flaps, free tissue transfer, and use of implantable materials for reconstruction or repair due to cancer, trauma, burns, superficial injury, congenital defects, or disease. Plastic surgery nurses help the patient to express psychological, physical, and psychosocial needs in order to regain or rediscover coping strategies and successful interactions with society. Thorough assessment and documentation before, during, and after surgery is essential for proper evaluation of healthcare consumer outcomes.
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