Operating Department Nursing - Essay Example

Running head: OPERATING DEPARTMENT NURSING Operating Department Nursing [The of the appears here] [The of the appears here] Operating Department Nursing Introduction & Summary By the end of the 19th century, operating department nursing was of such prestige that it became recognized as nursing's first specialty. Nursing duties at that time amounted to controlling the patient's environment, preventing infection, preparing the necessary equipment and providing care for the patient during surgery. A skilled nurse was allocated to the operating department and she was responsible for the 'at table' activities involved in attending the surgeon. She required an understanding of the idiosyncrasies of each surgeon to ensure that each operation ran smoothly. As a result of the status involved in working with the surgeon, the role of the operating department nurse was seen as one of prestige and great responsibility (Kneedler & Dodge 1991). Other activities, such as assisting in the anaesthetic and recovery rooms, were carried out by ward staff who stayed with the patient, provided necessary care or observation during surgery, and then returned to the ward with the patient where they cared for them until discharge. Therefore, it was not uncommon for a nurse to provide continuous care for the patient before, during and after surgery, an idea similar to named nursing. Rationale for the Study The world wars, 1914-1918 and 1939-1945, had a profound effect on the role of the nurse in general and on the role of the operating department nurse in particular. Demographic and social changes occurred, meaning that the workforce available to nursing generally increased. Horrific war injuries sustained from the ever-advancing military technology resulted in the development of pioneering new surgical techniques and equipment. Surgery became increasingly specialized and aggressive. In North America, the scope of the nursing role increased and nurses adopted a more proactive role in the management of patient care (Kneedler & Dodge 1991). However, the portrayal of events depicted that this was not so evident in British nursing at that time and operating department nursing extended little beyond an endless succession of housewifely duties. In the post-war years, technological advancement had considerable impact on the nurse's role. The 1950s and 1960s saw the introduction of presterilized swabs, disposable syringes and preset instrument trays. The need for sterilized equipment became so great that the centralization of surgical services took place. Central sterile supply departments (CSSD) were developed with a specific remit to sterilize equipment and dressings. Musgrave Park Hospital in Belfast became a pioneer hospital for this service in the early 1960s. The ultimate effect was that operating department nursing in the late 1960s involved considerably less housework than in the previous two decades. By the late 1800s a specially constructed room for surgery was provided, furnished with the modern equipment of the time. Consequently at this time there was a need for preparation and maintenance of the equipment, as well as assistance in using it. By 1880, the operating department rotation had become a routine part of the nursing general training programme (Kneedler & Dodge 1991). The role of assisting the surgeon fell to nurses because they possessed the qualities that were required for surgical work in this new era. In contrast to the physical attributes required in earlier times, the surgical assistant also needed to have the qualities of diligence and obedience. Literature Review Findings Although it was reported that operating department nursing was the first specialty within the nursing profession, it was some time before the first formal definition of practice appeared. In fact, it was some 70 years between the time when operating department nurses were first formally employed by hospital authorities and the time when the first definition of operating department nursing actually emerged. There is a proliferation of papers relating to the actual components of the role that operating department nurses undertake, and some interpretations of the nursing role in the operating department are clearer and more developed than others. Regardless of individual viewpoints, there is a general consensus that the role of the nurse in the operating department is not straightforward. Researchers in the past have suggested that an inherent complexity in the role has made it difficult to define. The role of the operating department nurse should only be considered in the light of its contextual difficulties. Grundemann (1970) states that clarifying the role is complicated by the social and physical structure of typical hospital operating suites, usually isolated from other patient care areas. Analysis of the role of the nurse in the operating department can he approached from different perspectives. Researchers have tended to look at role components in a collective way by exploring the patient-related, environmental and medical/technical tasks which need to be performed (for example, Grundemann 1970). Texts, on the other hand, have expounded the nursing role under temporal phases of care, such as the preoperative, the intraoperative, and the postoperative periods and the tasks required of the nurse during each of these phases. (Kneedler & Dodge 1991) Further, there is no clear agreement as to whether the role of the nurse in the operating department is one that is dependent on, or independent of the medical profession. Grundemann (1970) suggested that the frame of reference for nursing action had shifted from its earlier concentration on disease and the medical diagnosis to the individualized care of each patient. Consequently, the idea of assisting the surgeon by handing instruments, while at the same time caring for the patient during the operative procedure, can create ambivalence. Dodds (1991) viewed operating department nursing as having an independent role in relation to identifying the needs of each patient, being professional, offering individualized care, being totally accountable and advocating for the patient. While she highlighted the independent function of nursing there must be an acknowledgement that much of the clinical practice of nursing, especially in the operating department, is actually defined by, and under the control of the medical profession. Therein lies an important consideration. The reality of operating department nursing is that there are indisputably nursing actions which are in response to medical orders and treatment during anaesthesia and surgery. For example, the type of wound dressing used at the end of an operation may be controlled by the surgeon, the role of the scrub nurse is medically influenced, and so too is the role of the nurse in assisting the anaesthetist. McGarvey (1998) in a qualitative study explored the role of the nurse using a case study approach to examine nursing practice in the operating departments of three hospitals. Data were collected by observing of 358 hours of nursing practice, interviews with 35 nurses of differing grades, and document analysis of the nursing care plans of 230 patients undergoing surgery. The study did not examine expressly as to how nurses defined their role, hut did indicate that many nurses had difficulty in describing it and tended to view their role in terms of a set of functions they performed daily, rather than an overriding philosophy of care. To further understand nursing in relation to surgery the perioperative role from the temporal orientations set out by the preoperative, intraoperative and postoperative phases of nursing care should be studied. Conclusion This paper has considered the historical development of operating department nursing to the current day. However, concerns are raised that unless the role of the nurse in the operating department is further clarified and examined, it presents only a tenuous basis for future role development. In the UK, role definition of operating department nursing is patchy and research into the nursing practice is scant. Studies are small and have not addressed issues of role definition and development directly. In recent years, despite the changes in nurse education and the drive for evidence-based practice, this situation has not improved, yet the operating department is promoted as an exciting environment within which to work. As a result, there is a real danger that role development will occur in line with the overriding pressures from hospital management, technology and the medical profession, instead of in line with the needs of patients and the fundamental principles of nursing. Recommendations It is imperative that operating department nurses engage collaboratively in a comprehensive and rigorous programme of research that examines their practice so that they can determine where their contribution to care is best made in the future. Such research must include: further exploration of the perioperative role to develop a theoretical base for nursing practice; ascertaining those nursing activities that are of benefit to surgical patients and those that are not; determining the outcome from new role developments. Nurses must start to build a future for their professional practice that is built on sound theoretical principles rather than on just historical legacy alone. References Dodds F. (1991) First class nurses or second class doctors British Journal of Theatre Nursing 1, 6-8. Grundemann B.J. (1970) Analysis of the role of the professional staff nurse in the operating room. Nursing Research 19, 349-353. Kneedler J.A. & Dodge G.H. (1991) Perioperative Patient Care 2nd edn. Jones and Bartlett Publishers, Boston. McGarvey H.E. (1998) The Operating Department: Investigating the Role of the Nurse. Unpublished PhD Thesis, University of Ulster, Coleraine. Read More