Introduction

You are now undertaking a course at a university which will lead to a qualification as a nurse and also an academic award of a diploma or degree. From September 2013, all pre-registration nursing programmes in the UK will be undergraduate degree programmes. The Nursing and Midwifery Council (NMC) which sets out the standards and competencies expected from a qualified nurse also sets out the expected time required for learning in practice. This varies in different countries, but in the UK this has to be 50% of your programme. This 50% can be experienced in many ways, including short visits to learn what happens in such places as the school nurse service or the law courts. These may be part of a theoretical-based module in the university or part of a much longer placement experience. This book mainly focuses upon these longer placement experiences, although different aspects of caring for someone who is undergoing a surgical procedure of any kind are also explored.

Some of you may also experience what is called a ‘hub and spoke’ placement experience, where you have a base in your main placement but, during the whole of that placement, you may undertake shorter periods of time in other linked areas. Examples of these kinds of placements are found throughout the book.

Depending on the structure and management of your learning experiences in the practice environment and, of course, which field of practice or branch of nursing you are undertaking, you may have a placement which is known as a ‘surgical placement’. Most surgical placements are encountered within a hospital, although you may see surgical procedures and care in other contexts such as a health centre.

What is surgery ?

Before we determine what a surgical placement is, it is important to determine what we mean by surgical and surgery. The term ‘surgical’ implies some kind of surgery which involves an operative or invasive intervention – an operation normally involves ‘cutting into’ various parts of the body. An example is removal of the gall bladder through a laparoscope, which is a long, thin telescope with a light and camera lens at the tip which is passed through a number of small cuts in the abdomen but doesn’t involve large wounds. This allows the surgeon (the doctor who performs the surgery) to view the internal organs on a monitor. Surgery may be exploratory and diagnostic, or it may be life-saving following a serious life-threatening trauma. Although the principles of surgery remain the same, the way in which surgery is carried out has changed significantly. A brief overview of the development of surgery over time will enable you to understand why some patients may be frightened of undergoing any kind of invasive procedure and also why some procedures, such as removing sutures from some surgical wounds, are no longer carried out following surgery due to advances both in surgical techniques and technology.

Brief history of surgery

Although there is evidence of various types of what we would call surgical procedures taking place in the Middle Ages and before, for the purpose of this overview we focus on the nineteenth century onwards (1800 to the present day) and the images that many of us will have seen in relation to early surgical work, such as amputation without anaesthetic, management of pain or dying due to wound infection.

An excellent overview of the history of surgery over time can be found on the Channel 4 website: http://www.channel4.com/explore/surgerylive/history.html. As well as specific information about surgery generally, this site also has short videos of patients talking about their experiences of surgery and why it was necessary, for example a patient who underwent surgery for a pituitary tumour (http://www.channel4.com/explore/surgerylive/surgical4.html). This website also offers an insight into some of the roles of individuals during the intraoperative period, and in these short videos there are visual images of what the environment in an operating room or anaesthetic room is like.

Surgery today is, of course, very different due to advances both in surgical techniques and what we know about the human body. The most common cause of death after surgery used to be infection, but following the initial findings of Louis Pasteur (that the death of body tissue was due to bacteria in the air) and Ignaz Semmelweis (who discovered that ‘transmission of infectious diseases could be reduced by handwashing’ (Kozier et al 2008:644)), Joseph Lister, a British surgeon, introduced the use of carbolic acid and other antiseptic techniques ‘to kill bacteria in his operating theatres’ (Kozier et al 2008). Effective hand washing, as part of the much wider infection control agenda, is one of the key skills that you will need as a student and qualified nurse, not only in a surgical placement but every placement.

Alongside these discoveries and practices was the introduction of anaesthetic during surgery, early ones being ether and chloroform, which subsequently led to the more sophisticated techniques and preparations in use today (see Ch. 7).

Types of surgery

There are two main types of surgery: emergency and elective. Kozier et al (2008:644) define these as follows:

In addition to the two different types of surgery, there are two further subdivisions, namely major and minor. Major surgery involves a bigger risk to the patient, not only in terms of the organs of the body that may be involved but the intricacy of the surgery and possible postoperative complications that may occur (see Ch. 12). An example of this is a heart and lung transplant.

Minor surgery can also be intricate, but there is less risk and fewer complications. This kind of surgery is usually undertaken as ‘day care surgery’ (see Ch. 11). An example of this is removal of a skin lesion.

Surgical nursing placement

During your course, you may be allocated to a placement in an environment where surgery takes place. In the main, this will be in a hospital; however, more and more healthcare practices are now undertaking minor surgical procedures and you may be able to gain some experience of the basic principles of surgical intervention in a community placement.

For the purpose of this book, we consider a surgical placement as an area within a hospital where operative or invasive interventions take place. A nursing term often used in relation to surgery is ‘perioperative care’, which involves caring for the patient before admission to hospital, during the admission process, preoperative care (i.e. prior to going to the operating theatre), care during the operation and post-operative care (both immediately and until discharge home). The learning of principles underpinning these stages is transferrable to other placements where you may encounter a surgical procedure but where the focus of care for the patients is not surgery.

Surgical nursing, therefore, involves caring for patients throughout their perioperative journey. To care for patients during this time requires both general and specific knowledge and skills, depending on the nature of the surgical intervention and the individual needs of the patient. A knowledge of the following is required:

See Chapter 2 for further information regarding preparation prior to undertaking a surgical placement. Also, access specific placement learning information relevant to your local NHS organisations on your university website.

Healthcare personnel on a surgical placement

As well as nurses with various titles, you will come across a number of other healthcare personnel while on a surgical placement. Table 1.1 lists those you might encounter in the preoperative period (some of whom you may also meet in a pre-admission clinic), with a brief summary of their roles. Tables 1.2 and 1.3 list those you might encounter during the intraoperative and postoperative periods, respectively, some of whom you will see at every stage of a patient’s journey.

Table 1.1 Roles of healthcare personnel in the preoperative period

Table 1.2 Roles in the intraoperative period

(adapted from Alexander et al 2006:915)

Table 1.3 Roles in post-operative period, including post-discharge home

Named role	Role description and responsibilities
Registered (ward) nurse	A nurse who has undertaken a programme of learning in practice and Higher Education and successfully attained registration as a nurse with the Nursing and Midwifery Council. The nurse can be newly qualified or have extensive experience and expertise in caring for patients who have surgical intervention. This nurse is often either the main nurse for the patient, the nurse in charge of the ward or a specialist nurse focusing on helping the patient with managing pain for example or works in a specialist field such as breast cancer care.
District nurse	District nurses play a crucial role in the primary health care team. They visit people in their own homes or in residential care homes, providing care for patients and supporting family members. As well as providing direct patient care, district nurses also have a teaching role, working with patients to enable them to care for themselves or with family members teaching them how to give care to their relatives. District nurses play a vital role in keeping hospital admissions and readmissions to a minimum and ensuring that patients can return to their own homes as soon as possible (NHS Careers, http://www.nhscareers.nhs.uk/details/Default.aspx?Id=916%20)
Health visitor	A health visitor is a qualified and registered nurse or midwife who has undertaken further (post registration) training in order to be able to work as a member of the primary healthcare team. The role of the health visitor is about the promotion of health and the prevention of illness in all age groups (NHS Careers, http://www.nhscareers.nhs.uk/details/Default.aspx?Id=807)
Healthcare assistant	Healthcare assistants can work within hospital or community settings under the guidance of a qualified healthcare professional. The role can be very varied depending upon the area in which the person is employed. Working alongside nurses, for example, they may sometimes be known as nursing auxiliaries or auxiliary nurses. Healthcare assistants also work alongside qualified midwives in maternity services. The types of duties include the following: •  washing and dressing •  feeding •  helping people to mobilise •  toileting •  bed making •  generally assisting with patients overall comfort •  monitoring patients conditions by taking temperatures, pulse, respiration’s and weight (NHS Careers, http://www.nhscareers.nhs.uk/details/Default.aspx?Id=807) Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: Case study 1: caring for a patient in a day care unit Case study 2: caring for a patient in a general surgical ward Preparation for and undergoing an anaesthetic prior to surgery Undergoing surgery: the operating theatre experience Stay updated, free articles. Join our Telegram channel Join Tags: Placement Learning in Surgical Nursing A guide for students Mar 18, 2017 | Posted by admin in NURSING | Comments Off on Surgical nursing in context Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access