Learning Plan Outcome for Recovery Nursing - Essay Example

Learning Plan Outcome Report: Recovery Nursing Introduction In the previous assignment, the learning in postoperative recovery was assessed with the objectives of learning. Recovery room nursing practice comprises of delivering immediate postoperative care to the patients undergoing surgery. It is a very important area of nursing work. Thus I needed to revise my learning objective. Previously it was decided to have my learning on perioperative nursing. The area was too broad to focus on any particular aspect of care where skills of nursing could be learned. Later, it was decided that recovery room nursing would be better, since there are specific areas of learning, and a particular skill can be focused upon. The revised learning objectives were acquiring skills of recovery nursing both in clinical assessment and management of the postsurgical patients in the immediate postoperative period in the recovery room. This learning would also provide opportunity for application of knowledge and skills in the real situation where the learning along with evidence from research in recovery room nursing would be understood and applied in order to be able to deliver most appropriate care for the postoperative patients in the recovery room (Williams et al., 2002). The best way, thus, would be to constantly update personal knowledge and skill learning. The competency standards talk about accountability, and the best method to ensure accountability is to deliver care based on the state of the art learning (ANMC, 2004b). Specifically the learning would involve clinical assessment (ANMC, 2004a) and management of respiratory problems, pain management, management of nausea and vomiting, and documentation of care. Fact Sheet on the Role of Recovery Room Nurse Q1. What is the aim of recovery room nursing Ans 1. The aim of recovery room nursing is provision of intensive observation and care in the postoperative patients, especially when the procedure had been done under anesthesia (Leykin et al., 2001). Q2. What are the primary objectives of nursing care in the Recovery Unit Ans 2. The primary objectives are recognition of major potential problems associated with a specific surgical procedure and initiation of appropriate corresponding actions. The nurses must be able to identify and demonstrate general procedures which are routine in the recovery unit, where the care will be documented until consciousness and physical functions are totally back to normal for legal reasons. It is better they use an established scoring guide for this reason (Wilkins et al., 2009). Q3. What are the serious events in the recovery unit that a nurse must watch for Ans 3. Respiratory problem, cardiovascular problem, and hemorrhage. Respiratory arrest is not uncommon in this liable and vulnerable situation. The nurse must be able to take corrective action promptly (Leykin et al., 2001). Q4. What are the primary goals of recovery room nursing care Ans4. These involve continuous, close monitoring, vigilant patient assessment; safe recovery from anaesthesia & surgery; skilled nursing action & patient management; prevention of, or early recognition & intervention of post anaesthetic/surgical problems; short-term intensive care nursing leading to optimal patient outcomes (Radford, 2003). Q5. What should be focus in care Ans5. The nurses must be competent and continue to assess their own competence. Immediate postoperative recovery care is important since in this phase many patient deaths may occur. Most of the deaths occur due to specific anesthetic errors, errors in judgment, lack of vigilance, and these can be prevented. Nursing care must focus on prevention of complications and their treatment if they occur (Radford, 2003). Q6. What should be the staffing ratios Ans6. Depending on the care needs and criticality of the condition, the staffing ratio varies. There is a recovery patient classification system, and based on that there are 4 classes, I, II, III, and IV, where the nurse patient ratios should be 2:1, 1:1, 1:2, and 1:3 respectively (Leykin et al., 2001). Q7. What does class I comprise of Ans7: This class would comprise of patients with need of critical patient intervention, with complications, with need for resuscitation, and patients demonstrating violent behaviour needing restraint (Bruce, 2000). Q8. What does class II comprise of Ans8. All patients on admission to recovery unit would need careful and intensified vigilance. All pediatric patients fall into this category (Konig et al., 2009). Patients who are demonstrating signs of airway compromise or would need respiratory support in the form of mechanical ventilation, endotracheal tube, laryngeal mask, laryngeal airway also fall into this category. Patients with unstable circulation needing continuous hemodynamic monitoring will also belong to this class. Patients placed on pain protocol or in need of frequent medications, in need of frequent assessment, with some complications, in need of constant nursing interventions, or as decided by the team leader will also belong to this class (Radtke et al., 2008). Q9. What does class III comprise of Ans 9. Apart from that some patients would need very frequent monitoring. These patients would need monitoring of vital signs and recording frequently. The patients in need of ECG monitoring would also fall into this class. Those patients with confusion and restlessness due to any cause would be started in this category, and it is to be remembered that these patients may change rapidly to class I due to deterioration during the course (Brown, 2008). Q10. Which patients will belong to class IV Ans 10. Some patients' class is deliberately class IV due to their need for less frequent monitoring, due to their stable postoperative conditions and the minimal nature of their surgery. They need periodic evaluation and assessment of vital signs every 15 minutes (Seim et al., 2006). Q11. Why documentation of care is necessary Ans 11. The patient's record is a medicolegal document, and it proves the care provided. Surgery is an area where legal issues may arise quite frequently. Therefore documentation of all record demonstrates accountability. Moreover, the progress or deterioration of the patient may become evident to a consultant if he needs to intervene in case of complications (ANMC, 2004a). Q12. What are the most important parameters of care in the recovery room Ans 12. For the nurses, the foremost is evaluation of the airway in a postsurgical patient. Measuring and documenting vital signs are the second most important care parameter that a nurse must fulfill (Millar, 2004). Q13. How the airway is assessed Ans 13. The nurse must look for normal rise and fall of the chest with breathing. The colour of the face, neck, lips, and mucous membranes must be observed for cyanosis with confirmation of the breath sounds. This should be correlated with assessment of rate and depth of breathing (Dexter et al., 2005). Q14. How the circulation is assessed Ans 14.The circulation is assessed by monitoring pulse rate, blood pressure, colour of the skin, and examining the wounds for any hemorrhagic drainage. In the recovery room automated monitors are used (Currey and Botti, 2005). Q15. What are the criteria for discharge readiness Ans15. Ability to breathe spontaneously with oxygen saturation of 97%, demonstrable hemodynamic stability, appropriate neurological orientation, normal temperature, VAS pain score of 4 or less (Starritt, 2000), normal urine output of 5 cc/kg/hr, no nausea or vomiting, no anxiety or agitation, surgical bleeding within normal limits, and okayed by the anesthesiologist (Smith et al., 2008). Critique of the Fact Sheet This fact sheet is designed for the graduate nurses so that they get an overview of the necessary nursing skills required in the recovery room nursing. In this short span, it is not possible to delineate all the details necessary; however, this is a brief minimum that needs to be accomplished in care delivery in the recovery rooms. In the recovery, the most important problems related to the patient's condition would be indicated by vital signs and status of breathing (Richardson, 2002). This author has tried to connect academic learning, evidence from research, and practice needs in a single short document which can be referred during practice (ANMC, 2004b). Following this assignment, this author contemplated to learn the ECG and ventilator interpretation and skills of intubation in the recovery room. Research has suggested that nursing can play important roles in recovery room care. The recovery room nurse must be able to initiate emergency resuscitation in care its need arises in the recovery room. Knowledge and insistent enquiry thus become the mainstays of care. In the recovery room, the nurse must deliver care against postoperative nausea and vomiting and pain relief (Sokal et al., 2006). As nurses, they are required to provide evidence-based nursing care to people of all ages supporting the management of their postoperative conditions, which includes mental support and alleviation of pain. In order to do that, the nurse assesses, plans, implements, and evaluates nursing care in collaboration with anesthesia and surgical team. In the perioperative nursing area, her role is a leadership role which involves coordination of care within and across different care contexts to facilitate optimal health outcomes of the patient. This duty of care will be delivered and performed in accordance with recognised standards of practice. It is important to clarify nursing roles and responsibilities for different aspects of care with the anesthesia and surgical teams (ANMC, 2004b). Repeated assessment of the patient and the documentation of records should go along due to legal relevance of the records of care (ANMC, 2004b). Although brief, this fact sheet contains the basic essentials that will help the graduate nursing students find explanations about what they are doing, why they are doing so, and what more they need to do (ANMC, 2004b). Any new variations encountered must be researched to gain the complete knowledge and related skills, since these are very important from the legal, organisational, and professional standpoints (ANMC, 2004a). Workshop Reflective Critique In the workshop, I could learn the care process in the recovery room. The first was the learning about the emergency resuscitation tray. All the instruments necessary and how they need to be arranged during a resuscitation procedure was a very significant learning. The next step was to understand how to assess a patient and continuously monitor him and record the details. Enquiry and critical approach to existing practice were the very important steps since interpretation of the findings would lead to a specific pattern of care. Referring to the graduate qualities, the nurse literally gathers, evaluates, and deploys relevant information from these findings to solve a problem in care, and in doing so, a continuous assessment of learning happens that may help her to define questions related to care that needs to be researched. When problems are diagnosed, she is supposed to treat the problems, and all these problems are opportunities for learning (Heikkinen et al., 2005). This would need a collaborative approach and teamwork with organisation, planning, influencing the team members, and negotiating the best care with them (ANMC, 2004b). It was clear that each parameter of discharge readiness actually indicated a parameter of the vital signs that indicate the safety range of the patient, where discharge from the recovery room would not cause any harm to the patient. Thus I understood the importance of review of the signs. The pain score or Apgar discharge protocol is a handy tool to assess it. It was needed to document all care processes, and the ward must be readied to receive the patient. One of my significant learning experiences was to learn how to prevent airway obstruction. In this workshop I learned the skill of holding the chin to support the airway and to put the jaw up to open it up, and i also learned the skill of using a bag mask ventilator which can support the breathing through supply of 100% oxygen in an emergency situation of acute respiratory failure. A self-directed learning approach in acquiring the knowledge, skills, and attitudes was employed so the graduate nursing qualities develop. The goal was to accomplish skills and competencies in recovery room nursing in the manner that a graduate nurse need to acquire within the competency framework for nurses as per ANMC standards (ANMC, 2004a). Conclusion Recovery room nursing is an important area of nursing specialty. As a future registered nurse, this could be important area of learning to deliver nursing care. Continuous assessment and vigilant monitoring of such patients are important needs, and for that the graduate nurse needs to acquire competencies and nursing skills suitable for care delivery for these patients, especially in the areas of airway assessment, vital signs monitoring, hemodynamic monitoring, pain assessment and management, assessment of suitability of discharge from recovery room, and collaborative care when need arises and as a part of the routine. Reference List ANMC (2004a) Competency Standard. ANMC. ANMC (2004b) Graduate Nursing Requirement. ANMC. Brown, DN., (2008). Pain assessment in the recovery room. J Perioper Pract; 18(11): 480-9. Bruce, M., (2000). A study in time: performance improvement to reduce excess holding time in PACU. J Perianesth Nurs; 15(4): 237-44. Currey, J. and Botti, M., (2005). 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