Surgical Nursinging and Its Role - Essay Example

This paper discusses advance ments that are filled in by patients and the surgical nurse's role during this process. The paper examines advance statements and then discusses how surgical nurses play a role. Advance Statements and The Surgical Nurse's Role Undergoing surgery or any kind of treatment in hospital is not a pleasant experience. On one hand one is away from home and family and on the other hand hospitals tend to give most people the jitters. Hence it is not surprising that once admitted into the hospital patients feel depressed and lonely. It is the duty of the hospital staff to make sure that patients stay mentally strong and happy. Although every member of the hospital staff is important in their own way but it is the Nurses who play an integral role in caring for the patient and ensuring that all their legitimate wishes are abided with. Amongst the nurses it is the theatre nurse who ensures that all instructions are followed with respect to patients consent for surgery and if for any reason the opportunity for consent was not available then all alternatives need to be weighed and the best option selected. The nurse plays the role of a guardian cum chaperone even when it comes to the formal filing and explanation of advance statements. A patient is legally entitled to decide which life-prolonging treatment he or she would want to receive. It is also the responsibility of the healthcare staff to be aware of patient's treatment preferences (Matesanz 2006). Admission evaluations should include questions about the advance statement so that the patient's wishes can be clarified. When the hospital staff (normally the surgical nurse) record advance statements, they should ensure that they are not vague as this will leave the statement open to subjective analysis by the family or hospital staff (McCahon 2001). For any form of consent to be legal it must be given freely and without pressure and after the individual has been informed of all the pros and cons. "For a person to have the capacity to consent, he or she must be able to understand and retain information related to the decision made and be able to weigh the benefits and drawbacks involved in such a decision" (RCN 2004). "An advance statement is an expression of a person's wishes about medical care, to be used to guide doctors should circumstances arise when that person is unable to make or communicate decisions. It is also called a living will, advance directive or advance refusal." (Fiona Haas 2005). Typical advance directives include: Name, address and birth date of birth of person making the living will Any distinctive physical marks Name and address of GP (stating if she/he has a copy) Location of storage of living will List of people with a copy, and their contact details Date of writing and date of reviewing Signatures by two witnesses Statement of independence of witnesses and relationship to maker of living will. The living will normally also includes details of the state that it should take effect in if the maker becomes incapable of making decisions and specify any treatments that will be refused. The living will should also state the circumstances in which it will apply and if wished it shall state that a decision to refuse treatment should apply even if the treatment is necessary to sustain life. If a person of sound mind makes a voluntary and informed decision not to undergo a particular treatment then this decision needs to be respected even if this decision will result in a gradual or immediate deterioration of health. The only exception to this is in the case of circumstance defined by the Mental Health Act 1983 (DH 2001a). According to Rashid, Kass-Bartelmes and Hughes treatments commonly listed in advance statements are mechanical ventilation, CPR, antibiotic therapy, surgery and artificial hydration and nutrition (Rashid 2000, Kass-Bartelmes and Hughes 2003). According to British Law if an advance directive is made properly under the conditions that make it valid then it is treated equivalent to a refusal made at the time that the treatment is offered. Many patients may be decisive about not wanting medical treatments to keep them alive in certain circumstances, but they may not be aware of alternative treatments as even nurses and doctors could have difficulty listing all possible treatments that might be used to prolong life. However, the requirement to specify a treatment may be qualified by the following clause: "A decision may be regarded as specifying a treatment or circumstances even though it is expressed in broad terms or unscientific language" (Department of Constitutional Affairs, 2004). With all this level of legality it is the surgical nurse who ensures that all formalities with regards to advance statements have been completed prior to any major surgery. Although it may be the normal nurse who has dealt with the patient on a prior basis it is the surgical nurse's duty to ensure that the patient is of sound mental health. The surgical nurse needs to come to this conclusion to ensure that her patient has not signed or rather finalised his "advance directive" without being in a rational state of mind. Most patients respect their doctors but are open to talking about almost anything with their nurses. Hence the surgical nurse has to ensure that she/he is aware of future surgery patients and their needs. In the case of those patients who have given a "living will" with a number of instructions it is the surgical nurses duty to ensure that the doctor and eventually the patient is made aware of any alternative treatments for the patient that were overlooked . The surgical nurse should be aware of the revocation details on the patients advance directive. Normally an advance directive is revocable even if it states that it is irrevocable or revocable only in writing hence a written advance directive can be retracted orally. In many instances it is very important for the surgical nurse to understand the basis of the advance directive which could range from an act of faith to something that is a personal matter of the patient. The reason being that the surgical nurse needs to ensure that when the patient does actually face a grave, life-threatening situation any doubt should be resolved in favour of the patient's best interests and therefore "beneficence outweighs respect for autonomy." Patients need to regularly review advance statements because sudden treatments may be developed and hence the patient could change his or her mind at any time overriding the previous statement. The surgical nurse has an important role in this aspect as well as it is the surgical nurse who needs to ensure that the patient has been made to review his advance statements regularly and made aware of any new treatments or any changes to treatments. We can never underestimate the importance of the surgical nurse as she is one of the last people to have verbal contact with the patient prior to surgery. Hence she must ensure that the patient's rights and wishes have all been taken care of in a dignified and sensible manner and leaving no room for mistakes. Advance directives are platform for patient advocacy but as Carper said "Codes will not provide answers to the moral questions in nursing, nor will they eliminate the necessity for having to make moral choices". Works Cited 1. Carper B (1978) Fundamental patterns of knowing in nursing. Advances in Nursing Science. 1, 1, 12-23. 2. Department for Constitutional Affairs (2004) Mental Capacity Bill Fact sheet London: DCA. http://www.dca.gov.uk/menincap/mcbfactsheet.htm (Last accessed: March 9th 2007.) 3. Department of Health (2001a) Reference Guide to Consent for Examination or Treatment. The Stationery Office, London. 4. Department of Health (2001b) Seeking Consent: Working with People with Learning Disabilities. The Stationery Office, London. 5. Fiona Haas (2005) Understanding the legal implications of living wills VOL 101, NO 34, 18 Jan 2005 Nursing Times p36 6. Kass-Bartelmes BL, Hughes R (2003) Advance Care Planning: Preferences for Care at the End of Life. Research in Action. Issue 12. http://www.ahrq.gov/research/endliferia/endria.htm (Last accessed: March 9th 2007.) 7. Matesanz Mateu B (2006) Advance statements: legal and ethical implications. Nursing Standard. 21, 2, 41-45. Date of acceptance: April 11 2006. 8. McCahon CP (2001) Lessons learned. American Journal of Nursing Critical Care Extra. 101, 2, 24AA, 24CC, 24EE-24GG. 9. Rashid C (2000) Philosophical implications of the use of advance statements (living wills). Nursing Standard. 14, 25, 37-40. 10. Royal College of Nursing (2004) Informed Consent in Health and Social Care Research. RCN Guidance for Nurses. RCN, London. Read More