Theatre Nurses Equipped Term Paper

Pages: 25 (7009 words)  ·  Bibliography Sources: 1+  ·  Level: College Senior  ·  Topic: Health - Nursing

SAMPLE EXCERPT:

[. . .] Communicate approximate length of operation, any requirement and essential resources to the waiting list office, bed management, operating theatre department and/.or theatre scheduler.

Contact all patients failing to attend pre-operative assessment to identify the reason. Act on the reason, following local protocols for the management of DNAs in pre-operative assessment." (NHS, 2005)

Role of Nursing Team in Pre-operative Assessment

Further needed in comprehension is the role of the nursing team. The nursing team performs clinical examination and emergency assessments of all patients in the ER before surgery takes place for the purpose of ensuring that the fitness of patients is provided for to the greatest possible extent. Strategies include, "redistributing cases from emergency to elective theatre schedules, day case emergency surgery, and booking parts of the emergency care process." Stated is that, "these strategies have resulted in significant operational clinical improvements in the care delivery for emergency and surgical patients." (NSH, 2005) This is inclusive of the following:

'50% reduction in cancellation of minor emergency surgery from emergency lists.

Reduction by half of the admission to surgery time for minor emergency surgery.

97% of minor procedures have their emergency operation complete within 24 hours of admission with man y not having to stay in as an inpatient.

Fractured neck or femur, admission to theatre time has halved to 1.6 days with a reduction in length of stay of 10 days.

Theatre utilization has risen to 73% from 37%.

Reduction in 'out of hours' operating by 23% with only 12% emergency patients operated on during this time." (NHS, 2005)

Research shows specifically from conduction of a general study focused on inpatient pre-operation assessment the following findings and results of the general study:

100% attendance for operations.

100% of patients reported they did not expect this level of input at their outpatient appointment and all were please that it was so.

80% of patients had further investigations completed in accordance with their diagnosis and general health.

100% of patients felt prepared for their operation.

In a study entitled "Preoperative Information" written by Knobel & Hassfeld (2005) which states that many empirical studies have identified the quality a communication of patient information as a major weak point in the treatment process. In this study it was shown that multimedia presentations improved the quality of preoperative patient information making it 'sensible' to use modern media toward the end of provisioning graphic information to the patient. In a separate study which "quantified the accuracy of trained nurses to correctly assess the pre-operative health status of surgical patients as compared to anesthetists." (van Klei, 2004) In this study of 4540 adult surgical patients the health status of the patient was assessed first by the nurse and then by the anesthetists. The question which an answer was being sought for was: "Is this patient ready for surgery without additional workup?" Stated to be the secondary outcome was the amount of time utilized for completion of the study. The nurses and anaesthetists and nurses did not know the results of one another's answers. Results were as follows:

87% of the patients were classified similarly by the nurses and anaesthetists.

The sensitivity of the nurses assessment = 83% (95% CI: 79-87%) and the specificity 87% (95% CI: 86-88%).

In 1.3% (95% CI: 1.0 -- 1.6) or patients were classified as 'ready' by nurses and anaesthetists did not classify them as such.

Nurses required 1.95 (95% CI: 1.80 -- 1.90) times longer than anaesthetists.

Findings are that by anaesthetists allowing the nurses to "serve as a diagnostic filter' in making identification of the subgroup of patients who are 'fit' to undergo surgery in lieu of further diagnostic testing frees the anaesthetists to focus on other patients that might require further attention prior to surgery. (van, Klei, 2004)

In a 2002 case study by Hastings and Rother for the NHS Trust it is reported that even the seemingly effective hospital ER has potential for improvement as is evidenced in the report of this case. The methodology of the study was questionnaires for patients (these proved to be ineffective) staff workshops, interviews with key staff and a patient's focus group all proved effective. This case study found that the pre-assessment nurse and anaesthesiologist working in coordination to "improve communication and patient informattion designed to reduce cancellations after admission for medical reasons was effective as to productivity. Recommendations from the study were as follows:

"Review the preparation of patients prior to surgery, including pre-operative checklist, patients' information and pre-operative assessment.

Review the management, roles and terms and conditions of SDU staff.

Introduce appropriate catering and other facilities for staff within theatres.

Redesign structures and multidisciplinary meeting arrangements within theatres to facilitate communication and analysis and monitoring of clinical standards." (Hastings and Rother, 2002)

Also recommended were the following:

"Evaluation of the potential benefits of an explicit operational theatre co-coordinator role.

Evaluation of the benefits of a unified theatre practitioner grade.

Likely to lead to major improvements, but is complex and may need external skills or resources.

The introduction of an improved theatre clinical information system.

Establish project team to assess the management of theatre scheduling and booking of operating lists." (Hastings & Rother, 2002)

For each recommendation it is stated in the report of the study that the following Recommendations were added to each:

(1) Set clear objectives for the proposals,

(2) Provided an 'audit trail' to indicate the basis for the recommendation, for example whether it arose from the staff workshops and interviews, from the patient survey/focus group and/or from the literature.

(3) Set out the actions required to deliver the proposal.

Further revealed by this study is that progress is being made citing as an example a "multidisciplinary working group which includes the anesthesiologist, surgeons, nurses, ODP in addressing issues concerning emergency theatre arrangements. A second development is stated to be "joint work by an Anesthetist and an orthopedic pre-assessment nurse to improve communication channels. The aim is to test new patient information (in paper and later electronic format) designed to reduce cancellations after admission for medical reasons. This work is in line with recommendations from the Pre-assessment Project within the Modernization Agency." (Stock, 2002) Listed as "main challenges faced by the team" was the space and time, or 'headroom' in which to do the work as well as the challenge of handling the work while handling a busy clinical workload simultaneously. Fatigue was listed to be a problem. Key lessons learned by the team were noted to be:

1) Make sure that the team has adequate time set aside for the work;

(2) It may not be possible to squeeze it in between other commitments;

3) Make sure from the outset that you have adequate secretarial and administrative support - don't wait until you are desperate for help!

(4) Be realistic about the scope of any review - keep the agenda manageable. The scale of this review was probably too broad.

(5) Recognize that the pace of the work will slow when other activities have to take priority.

(6) When you are asking people to work with you make sure that you work with them - help them to help you. Your priority may not be theirs - they will be facing their own pressures.

(7) If the work shows that you have got to build bridges between different parts of the organization - build them yourself. Don't expect others to do it for you.

(8) Think carefully before using a questionnaire to collect the views of patients - is it the best way?

(9) Take care when approaching patients - choose the 'right' time and the 'right' messenger. Nurses may be best equipped to tackle this task. (10) be aware that your efforts might be affected by any local merger agenda - be flexible and ready for change!" (Stock, 2002)

In the work entitled "Institutional Changes in Hospital Nursing" (Krall & Prus, 1995) it is stated that concerns related to the "recurrent shortages [of nurses] led many economists and health care specialists to explore the dynamics of the nursing labor market using neoclassical labor market analysis." Further stated is that, "As the length of hospital stay and severity of patient illness have increased, less custodial and more acute care is required by nursing personnel. As a result, many of the tasks performed primarily by lesser skilled nursing personnel may have been eliminated." The article states that the role of the licensed practical nurse are "rapidly disappearing from acute care hospitals as the shift to all RN staff picks up momentum across the country. The reasons are clear: As patient acuity grows and cost-containment pressures increase, nursing directors believe they must employ only nurses able to deliver the "broader range of care." Where staff cuts must be made, they say, the axe is bound to fall heaviest on LPNs and Aides" [American Journal of Nursing 1985, 1165].

In the work… [END OF PREVIEW]

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Theatre Nurses Equipped.  (2005, June 11).  Retrieved December 11, 2018, from https://www.essaytown.com/subjects/paper/theatre-nurses-equipped/8214058

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"Theatre Nurses Equipped."  Essaytown.com.  June 11, 2005.  Accessed December 11, 2018.
https://www.essaytown.com/subjects/paper/theatre-nurses-equipped/8214058.