Leadership and Management of Perioperative Care: Evaluation of Surgical Patients Journey - Essay Example

Running head: LEADERSHIP AND MANAGEMENT IN MEDICAL CARE Leadership and Management of Perioperative Care: Evaluation of Surgical Patients Journey You're Name University Abstract The surgical patients' journey can be a confusing one as it involves a mixture of specialists entering in the picture and discussing various medical issues with the patient during perioperative care. This research discusses the management of the surgical patient and how various areas are managed efficiently to provide quality care for the patient. It explores how the nurse, anesthesiologist, surgeon, general practitioner, and other specialists have a direct role in the managed care of the patient. A major importance is given in the surgical area of the patient, defining the role the operating physician has on the patients well being. There is also evidence given on how the care of the surgical patient is managed if an emergency arises such as an allergic reaction to specific pain medication or some other complication potentially developing within the routine care of the patient. The conclusion provides factual verification that it is the medical team working together which insures a positive patient outcome following a surgical procedure. Leadership and Management of Perioperative Care: Evaluation of Surgical Patients Journey An emergency surgical procedure can adversely affect a patient's care as there has to be effective leadership and management put in place to guarantee a positive patient outcome. The current patient entered into the surgical ICU after having routine care at his regular doctors' office but due to his habitual problems with cardiovascular pain his primary doctor was aware that a situation might occur that could lead to him having to have immediate heart surgery. This did in fact take place and the patient was picked up from his home by ambulatory care services. During transport the paramedics lost the patient and had to revive him. They also had to use a form of resuscitation because the patient did stop breathing at one point. This placed him above the queue of other patients who might have had scheduled surgical procedures. Therefore, by automatically following the HPC guidelines this patient was considered a priority one during transport. Furthermore, during transportation to the hospital he fell into a semi-comatose state after being revived and became barely coherent. was totally helpless, and was solely relying on the medical professionals taking care of him. The patient however was not aware that emergency surgery might take place but was aware he did have a medical problem that required monitoring of his condition. In situations such as this, one of the main areas that have to be appropriately managed and planned for is in regards to effective pain management during the perioperative period, anesthesia during the surgical process, and control of pain after surgery as well. One very effective method that is beginning to become main-stream in patient perioperative care and postoperative care is within the realm of therapeutic touch which has been shown to decrease patients anxiety levels and increase their pain tolerance levels when other more mainstream therapies have not been completely effective. Performing a technique such as this before surgery can be beneficial in that it helps the patient to relax (such as with this patient even though there wasn't total coherency) so that the positioning on the operating table can be easier achieved. In fact, the positioning of a patient on the operating table plays a part in how well the surgical process in itself can be achieved (Bard & Clancy 2005, p. 3). Over extending the limbs and joints when placing the patient has to be avoided and there needs to be consideration for how well the anestheologist will be able to perform their duties based on the positioning of the patient as well (Bard & Clancy 2005, p. 2). Furthermore, the placement of the patient during perioperative treatment needs to be monitored and proper equipment needs to be readily available to prevent any pressure points from developing that would result in lesions on the patient. For some it is hard to perceive how the positioning of this patient could become so tedious but research finds that something even this simple can make all the difference in the outcome following the surgical procedures (Bard & Clancy 2005, p. 2). Therefore it is an essential part of the perioperative care of the patient just as much as the pain management actually is as well. To provide more detailed explanation on the usage of therapeutic touch with this patient and how it can help relax the patient in order to position them correctly, the gathered research shows that this technique was carried out on this patient due to his high level of anxiety which was creating more pain and complications in his perioperative health care regimen. Therapeutic touch is a process by which energy is transmitted from one person to another for the purpose of potentiating the healing process of one who is ill, injured, or suffering from an emergency complication (Heidt 1980, p. 33). This type of pain management actually falls into the hands of the nursing team with the head nurse managing the majority of the routine care of the patient. This is why it was stated previously in this literature that perioperative care is a joint team process and it requires a variety of medical professionals working together to try and manage the patient's care and keep them as comfortable and anxiety free as possible. Many patients that are under perioperative care and who are on a medical surgical unit often request pain medication on a regular basis but still complain that it does not manage their pain effectively. This is one of the reasons why a therapeutic element has been introduced into this framework of care. Furthermore, through this form of treatment and management of pain the medical professionals are able to build a trust level with the patient which is a positive influence on the treatment procedures, especially in case an emergency situation arises that requires extreme measures to care and restore the patient to a stabilized position, such as has happened with the current patient (Heidt 1980, p. 34). Although this type of pain management is considered to be a form of holistic medicine many patients prefer this type of approach initially. They are always given the option to turn to narcotics if it proves to be ineffective in the management of their treatment. In emergency situations such as this one though patients can receive this treatment for relaxation purposes while also receiving narcotics through an intravenous line in their arm. This two put together greatly improve the possibility of relaxing the patient effectively enough to maneuver them pain free from one position to another for a surgical procedure. Also, research has shown that therapeutic touch is effective in promoting relaxation and reducing anxiety; changing the patients' perception of pain; and in restoring the body's natural processes. The importance of therapeutic touch to the field of nursing itself is tremendous. Because as was stated some patients do prefer holistic medicinal techniques many medical professionals have had to begin study in this type of therapeutic treatment for pain management procedures. Therapeutic touch is being supported and taught in many nursing schools in the UK in particular because of the quality of care it gives to patients and how well it manages their pain as well. It is put into practice in a wide range of settings from nursing homes to stress reduction of the nursing staff themselves to reduce "burnout", and as was stated it is utilized following surgical procedures that might have been planned as well as those that might have arisen out of an emergency need. Research indicates that therapeutic touch does produce significant levels of effective healing which has been stated and therefore its continuing usage in managing patient pain levels is considered to be essential in providing high quality patient care (Kramer 1990, p. 483). Patients' pain levels are managed by a number system showing what level of pain that they are in off and on throughout the day during a perioperative period or a few hours before a serious surgery. The pain rating scale that is normally utilized with patients in a perioperative condition consists of numbers from zero to ten with ten being the most excruciating pain ever felt by the subject and zero being no pain present at all. However, the management of the pain can be hard to facilitate because this scale is subjective in nature and therefore the validity and reliability can be somewhat compromised. The following outline shows how the management of pain control works with patients in this particular situation: 0-2 No therapeutic intervention is needed due to the pain level being relative to a mild headache 2-5 A mild analgesia is needed for pain relief which is equivalent to two Tylenol that can adequately control the pain level 5-7 Medical intervention is required for adequate pain relief by the utilization of prescribed oral narcotics 7-10 This requires the managing nurse to request a stronger narcotic from the doctor which will hopefully alleviate the level of pain, often done intravenously or through intramuscular administration (Heidt, 1991, p. 59). This is essential for the anestheologist as well because they have to have a clear perception of what the pain level is for a patient before surgery can proceed. Of course it is obviously clear that with this patient the situation was very unstable to start with so there could only be professional guesses as to how to control and manage any pain the patient might have been experiencing since communication was not totally comprehendible. Nevertheless, stabilizing a patient's condition, such as this young man who was brought into the emergency area is the number one concern of the medical staff. However the task in this situation is much more difficult as he does have complications with his heart and without immediate surgery could suffer a major heart attack which all of the medical staff are aware of. There has been avid discussion on the management of this patient's pain and stabilizing his condition but there is far more to this than simply the basic form of care and pain management that has been discussed. Now that this patient is seemingly stabilized the surgical team will step in to try and surgically repair this mans heart but by doing so they have a number of ethical concerns and responsibilities to this patient which have to be taken into consideration as well. The operating room staff has a mode of conduct and duty to the patient the same as any other medical professional has and therefore each surgical team member has to be careful not to threaten the balance of these ethics or make any rash decisions that could result in a negative outcome for the patient (Brundell 1900, p.22). During the interactions in the surgical operating room it is the power of authority that leading operating room staff members have over other surgical team members which plays a heavy part in the type of surgical care that is given to this patient. This ultimately has a large role in the determination of what the possible outcome will be for this patient, following the surgery (Flood & Scott 1978, p. 240). This is stated because the judgmental decisions and the authorizing body of many of the surgical actions are what can bring positivism for this patient or they can result in adverse complications for this patient. Surgeons are in a very difficult situation when faced with these cases because often there is a lack of consent for the surgery by the patient due to the emergency of the situation and also they have to be very careful to not overstep the liability laws that govern surgeons and other medical professionals, yet still provide quality care to this patient. However in this particular case the patient was semi-conscious and although he could not write he did nod his approval for the surgical procedure to be done. According to the laws governing the NHS this was sufficient to be determined as a form of consent. Surgeons have to look at many different areas before a surgical procedure and three of these are: Understanding and Obtaining Information (but in this case it was not totally possibly beforehand) Believing the Information (The patient was conscious enough to interpret what was being asked) The ability to weigh up and decide on the basis of the gathered information (which the medical professionals normally do) These three guidelines all follow the Thorpe test and again, in this case although verbal nor written consent could be given the law shows that as long as the actions are in the patients best interest then the medical staff can not be found to be intentionally trying to cause harm to the patient despite what the outcome might be (Davey & Ince 1998, p. 11). Also, since the 1980's the NHS has gone through numerous reforms that have placed certain other mandates regarding health care services onto medical professionals, and the surgical area has been affected by these as well. For instance, in this case if this surgeon is going to meet the requirements of cost effectiveness for surgical procedures that the NHS has established then of course he is going to have to provide concentrated and high quality care to this patient to avoid post-operative complications in the care regimen of this patient (Hamilton & Bramley-Harker 1999, p. 437). Therefore in the surgical operating area there is no room for mistakes or second-guessing during the surgical process or otherwise this could lead to more than one type of adversity that includes the patient but also the surgical staff as well. Many lead surgeons face "surgical auditing" as well so due to the fact that this case in an emergency surgery the surgeon has to insure that his performance is up to par because according to the reforms of the NHS this is the typical type of case that does get audited and the patient outcome is critically evaluated as well (Spiegelhalter 1997, p. 45). Therefore the surgeon needs to guarantee he has the full cooperation of the surgical team from the anesthesiologist down to the nurses assisting him in regulating the patients' body stats to the sterilization of the medical instruments as well. A surgical audit examines every aspect of a surgical emergency procedure and this is why the surgeon and the surgical team must be precise and accurate in the care of emergency patients such as this young man. As has been stated there is an abundance of judicial principles that surgeons and the surgical team are governed by and failure to meet any of these principles such as not acting with non-maleficence, beneficence, or supplying an idea of justice to the care of the patient can result in negativities in the operating procedures (Davey & Ince 1998, p. 9). Also, since the case of Donoghue v. Stevenson in 1932, any medical professional has had to be very careful to insure they are providing a strong duty of care to their patient, especially true for surgeons and the surgical team in the operating room. Beforehand this idea was sketchy but due to the controversies surrounding that case health care professionals are suppose to be highly aware of what their duty of care actually means to the patient, without question. Therefore, in this patients surgical journey it can be easily seen how every action of the leading surgeon could either be a positive influence to the patients recovery and improving health following the surgery or it could be an extreme negativity if there is a mistake by the surgeon or any other present body in the operating room, as has been mentioned briefly earlier. Furthermore, with regard to the very specific laws abiding over any medical procedure the medical professionals involved with this patients care need to pay close attention to these as well and make sure that they are familiarized with them or there could be repercussions arise here as well. Of course some have already been mentioned with regard to a duty of care and liability procedures, etc. There are many areas in the medical protocols that can easily be overlooked and jeopardized in emergency situations which again can concrete the existing concerns. The patient deserves proper care which in 1947 the National Health Service Act made it an official law that every patient deserves the right to care regardless of fees because at the time the service is given it is free. There are times when some doctors tend to overlook facts and laws such as these and there evolves hesitation in the treatment of the patient due to this. However, in this patients case no actions such as these occurred and his treatment has been progressing on a high standard, with all the medical professionals that have had a part in caring for him taking their role seriously and sincerely as well (Davey & Ince 1998, p. 10). It is essential that the medical team stay in this frame of mind because past experiences have shown that medical professionals are held accountable for many different types of patient experiences such as, mortality rate, morbidity rate, quality of life following surgery, length of stay in the hospital due to medical procedures, intensive care costs, and even hospital costs that the patient might acquire while being taken care of in the various systematic steps of this patient pathway (Cheng et al 1999, p. 2). Because the technique being used to perform the cardiac surgery for this patient is considered the "fast track method" there are even more issues of concern that can develop. However, if the perioperative care given before hand, such as having to perform the tracheal extubation on the patient before the surgery is carried out in a timely manner then the outcome brings resource utilization for the surgical team and for the patient it brings a more positive outcome in the long run (Cheng et al 1999, p. 3). Another area in the postoperative realm that can change the outcome of the patient has to do with how the medical team evaluates the postoperative acute physiology score or the (APS). It has been found that this has been one of the most powerful tools utilized following cardiac surgeries and the current patient has been found to be being evaluated using the same methodology as patients before him. The reason that this tool is so reliable and effective is that it helps to correctly evaluate the type of skill that was carried out during the surgery and reflects on all of the members of the surgical team. For instance, it grades the effects of surgical skill, anesthesiology management, the effectiveness of the immediate postoperative care, and the perioperative characteristics of the patient (Cheng et al 1999, p. 5). This is done to show exactly what area might have been lacking and how all of these areas, effectively working together have impacted the patient. In this patients case he did suffer a mild myocardial infraction while being operated on but through the extensive care and careful monitoring of his bodily stats this minor emergency was well taken care of and did not adversely affect the surgical procedure in anyway. Also it appears it did not adversely affect the patient either. The recovery of this patient did define itself in a positive way demonstrating that the surgical pathway was correctly facilitated and all medical professionals involved with this patients care followed the protocols and guidelines that were expected of them through the various policies of care within the NHS. There is one final area that had an impact on this patient and of which always plays a part in the admission process all the way through to the discharge process. This is the hospital environment and the policy of the hospital in particular. The structure of the hospital has stood out for many years as a precedent of medical care. It is a monument that is considered to be the heart where all appropriate medical care practices take place, especially in regards to cases such as the one that has been being discussed in this literature. Every hospital has its own irrefutable guidelines but the main is the one which declares that all patients have a legitimate right to equal and fair health care. This policy can be interpreted as a descriptive idea that lies over all hospitals within the UK. The hospital environment has its own impact on the patients recovery process as it is where all medical technology stems from (which was said) and therefore requires that all medical personnel abide by the policies set forth within the guidelines of the hospital. The hospital provides a social comfort for the patient so that medical testing and correct procedures can be carried out with a sense of trust from the patient to the medical providers. This is an essential part of the care and it was especially true in the case of the young man who was suffering from cardiac arrest and heart failure (Hosking & Haggard 1998, p. 3). In finality, this literature has shown how the bodies of the medical environment all work together to try and provide quality care and positive patient outcomes. It has laid out the framework of the legal structure of the medical process as well as the duty of care that is expected from the medical professionals to the patient. This patient's journey fared well due to the positive influence of the hospital environment and the attuned and expert skill of the medical professionals that worked with him. Without a structured framework such as this the NHS would definitely be lacking in the UK but fortunately this case gives a better view of how effective powerful medical care can really be to a patient. Insuring a good recovery for a patient, such as the one that has been discussed, and of which includes a high quality of life that can be looked forward to by the patient in the end is the main goal of the medical professionals in the UK. Total Word Count Excluding References and Title Page: 3, 680 You Required: 3,150 References Bard, Nicola & Clancy, John. (2005). Perioperative Practice. London: Taylor & Francis Ltd. Publications. Brundell, Carter. (1900)."Medical Ethics." International Journal of Ethics 11, (1), 22-46. Cheng, Davy & C.H. & Tirone, E. (1999). Perioperative Care in Cardiac Anesthesia and Surgery. England: Landes BioScience Publications. Davey, Ann & Ince Colin. (1998). Fundamentals of Operating Department Practice. Britain: Greenwich Medical Media Ltd Publications. Flood, Ann & Richard, Scott. (1978). "Professional Power and Professional Effectiveness: The Power of the Surgical Staff and the Quality of Surgical Care in Hospitals." Journal of Health and Social Behavior 19 (3), 240-254. Hamilton, Barton & Harker, Bramley-Robert. (1999). "The Impact of the NHS Reforms On Queues and Surgical Outcomes in England: Evidence From Hip Fracture Patients." Journal of Economics (109), 437-462. Heidt, P.R. RN,PhD. 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