Healthcare System: Nursing Contribution to Patient Recovery from Anesthesia - Essay Example

?Nursing contribution to patient recovery from anesthesia Introduction: The effectiveness of any healthcare system is ascertained by the degree to which healthcare providers offer positive and desired outcome to the patients as well as by the level of their professional knowhow which results in enhancing patient satisfaction (Lohr, Donaldson, Harris-Wehling, 1992). The post-anesthetic period is of crucial significance for surgical patients since they are highly vulnerable during the post-operative period. The impact of complex medical procedures to which the patients are exposed to such as surgery, anesthesia may lead to critical aftermath such as cardiovascular complications, fluid shifts, or even neurological dysfunction (Tollefson, 2004). The key objective of nursing care during the post-anesthetic period is hence centered on ensuring safe recovery of patients following surgery, promoting optimum physical comfort to enable speedier healing among the patients, restoring homeostasis (Miller, 2010) and taking active steps to prevent and/or minimize injuries. Perianesthesia nurses are entrusted with the responsibility of ensuring that the patient recovers safely from anesthesia and are taken care of in the post anesthetic care unit. The patients recovering from anesthesia are highly vulnerable to various complications. The perioperative nurses must hence ensure to take into consideration the patient's age, anesthetic agents, individual health problems etc which may directly impact the post-operative care and give rise to complications such as the risk of hypotension, bronchospasm, etc (Iyer, Levin, and Shea, 2006). The post anesthesia care is typically divided into three phases which include: Phase 1: Early recovery PACU In this stage the patient is transferred from the OR (operating room) to the Post-anesthesia Care Unit (PACU) and provided medical assistance immediately after the completion of a surgical procedure (Day, Paul, and Williams, 2009). This phase entails provision of intensive medical care to the patients which is the primary responsibility of the anesthesiologist or anesthetist (O'Connell et al., 2010). Phase 2: Self-care phase / Recovery room In this stage the patient is prepared for self-care or administered care in an extended care setting. The recovery stage may last for several days depending on individual circumstances of each patient (Day, Paul, and Williams, 2009). Phase 3: Discharge In this phase the patient is prepared for discharge from the hospital setting. This phase includes careful planning and handling on the part of the care givers which includes ensuring that the patient is fully restored to their pre-operative stage before discharge (Day, Paul, and Williams, 2009). Fig: Patient recovery from anesthesia – Recovery stage Source: Day, Paul, and Williams (2009: 501) The key role of nurses in ensuring effective recovery of patients from anesthesia is discussed in detail in the following section. Role of recovery nurse in ensuring patient recovery from anesthesia: One of the key requirements of ensuring effective patient recovery from anesthesia is to ensure that nurses have adequate knowledge and awareness regarding the patient's level of anesthesia since such awareness helps them to plan and develop appropriate safety measures (Spry, 2005). The perioperative or post-anesthesia care is one of the vital elements of nursing care. The traditional role and scope of recovery nursing has changed dramatically over the years with the result that the nurses today are required to provide high quality care and display advanced nursing skills with a view to ensure patient safety and speedier recovery. As the complexity of operating procedures increase, the role of recovery nurses providing post operative care to patients recovering from anesthesia is becoming more and more challenging. The introduction of advanced surgical technology and anesthetic techniques have brought about significant revolutions in enhancing patient satisfaction and shifted the role of nurses from ensuring regular observations of patient's vital signs to advanced and extend postoperative care. The nurses are now required to display critical skills in caring for the post-anesthetic patients in a non-ICU environment (County, 2004). The emergence of the patients from anesthesia especially from extubation marks a critical period in the process of provision of perioperative care and hence the recovery nurses are required to be by the patient's side to provide prompt assistance to the patient. This is because extubation drastically increases the chances of bronchospasm or larygngospasm reflex among the patients. The recovery nurses must hence check for airway blockage since such obstruction may cause the patient to choke or vomit due to lack of airway management and inadequate ventilation. The recovery nurses must hence ensure that a suction catheter is within reach and in a working condition, prior to extubation to ensure safety and well-being of the patient (Spry, 2005). The process of providing post-anesthesia care is divided into three distinct phases of recovery beginning with the immediate transfer of the patients to the PACU (Post Anesthesia Care Unit) which is the first phase, whereby the nurses are required to provide intensive care to the patients. This phase is then followed by preparing the patients for self-care or providing care in an extended care setting or in the hospital. The last phase entails preparing the patients for discharge. In this phase the nurses are required to ensure that the patients ready to be discharged are provided optimum care and support which includes provision of recliners and stretchers or beds appropriate to the health and physical status of the patients (O'Connell et al., 2010). The role of nurses during the early post operative phase i.e. the first phase entails closely monitoring the patients, ensuring effective pain management and checking their vital signs from time to time. The nurses are required to especially ensure there is no excessive bleeding, swelling, redness or signs of hematoma. The key purpose of recovery room care is to ensure that the patients are offered optimum care with a view to stabilize their health and minimize the risk and incidences of trauma and anesthesia (Hatfield and Tronson, 2001). Prior to receiving the patient in the PACU adequate care must be taken to ensure that the recovery room is perioperotive environment is conducive. This is because the perioperative environment plays a key role in influencing the health and recovery of the patients. The recovery nurse must hence take active steps to ensure that the PACU is devoid of any potentially hazardous elements and is safe for the patients. Post surgery the patients are highly likely to display signs of nervousness or anxiety. Such symptoms may hamper their ability to effectively communicate with the nurses or those around them. It is hence imperative for the recovery nurses to ensure that the patients are offered optimum support to reassure them and ensure that all their basic needs would be taken care of effectively (Taylor and Campbell, 2000). The role of recovery nurses is hence of crucial significance since it entails display of critical skills such as anticipating and preventing potential complications such as respiratory arrest or laryngospasm which are commonly observed reflex responses occurring in patients during the emergent phase of anesthesia (Kneedler and Dodge, 1994), likely to be encountered by the patients and deal with it quickly and effectively to avert any untoward situation (Pudner, 2005). The role of the recovery nurse is to immediately examine the health status of the patient on arrival and ensure that the patient's airway, breathing and circulation are functioning effectively (Starritt, 2000; Hatfield and Tronson, 2001). Respiratory arrest, as mentioned earlier, is a reflex response which commonly occurs among patients during the recovery phase. Furthermore post surgery patients are often observed to have increased respiratory rate due to anxiety or metabolic imbalance. Shallow respiration on the other hand is a direct consequence of continuing depression from anesthesia. Hence a thorough examination of the patients' respiratory patterns is inevitable during this stage (Kneedler and Dodge, 1994). It is the duty and responsibility of the perianesthesia or recovery nurses to ensure that the patients recover safely and completely from anesthesia after transferring them to the PACU. The recovery nurses are responsible for accurately identifying all vital information related to the patient such as the date and time of arrival of the patient, their history and allergies or other health conditions which may affect their recovery; assess their respiratory, neurological and skin conditions as well as constantly monitor their vital signs; and take active steps for effective pain management (Iyer, Levin, and Shea, 2006). Effective management is crucial because poorly managed pain attracts the risk of legal action among clinicians and results in a series of psychological responses such as anxiety and depression among the patients and their families. Pain is reportedly inadequately managed and continues to be so in various hospitals across the U.K. The under treatment of pain is one of the key concerns among the healthcare providers. Statistics suggest that almost eighty per cent of surgical patients in the U.K. reported to have experienced varying degrees of pain, ranging from moderate to severe, post surgery. This included patients of chronic illnesses such as cancer as well as elderly patients (Hughes, 2008). Impact of anesthesia and surgery on homeostasis: Ensuring effective recovery of patients from anesthesia is one of the vital elements of nursing care. It has been widely established through research that anesthesia and surgery triggers a metabolic stress response in the human body which in turn may overwhelm homeostatic mechanisms in the patients (Cousins and Bridenbaugh, 1998). Various studies have indicated the relationship between anesthesia and surgery on melatonin homeostasis. According to various studies general anesthesia is known to disrupt the circadian rhythm of melatonin secretion in both humans as well as animals. Such disruption in the level of melatonin homeostasis is associated with the postoperative sleep deprivation which is normally observed in post-anesthetized patients and patients of surgery. Similar observations were made by researchers in patients undergoing hysterectomy operations and orthopedic surgeries who were given thipental and isoflurane anesthesia (Watson, 2011). Hypothermia is one of the most critical complications arising on account of anesthesia. The normal human thermoregulatory system is responsible for maintaining the core body temperature near 37 degrees C. Normothermia is needed to reduce postoperative complications. Furthermore normothermia also helps in reducing the incidence of morbid cardiac events (Woodhead and Wicker, 2005). However anesthesia is often held accountable for causing perioperative hypothermia. Anesthesia significantly reduces the patient's ability to respond to cold causing their body temperatures to drop substantially post surgery and significantly increasing the health risks such as hypothermia (Mulholland and Doherty, 2011). It is observed that infants and young children are at an increased risk of hypothermia during surgery as well as to the impact of anesthetics (Wise, 2000; Stannard and Krenzischek, 2011; Cote, Lerman, and Todres, 2009; Shields, 2009). According to Lubin et al., (2010) anesthesia and surgery are often responsible for triggering certain physiologic responses in the human body as a means to preserve homeostasis. However such responses in patients with critical heart ailments may precipitate decompensation. In order to combat the stress of surgery the production of catecholamine increases significantly resulting in an increased demand for myocardial oxygen, which in turn causes a dramatic overload on the patient's heart. General anesthesia in pregnancy increases the sensitivity to intravenous (IV). It is hence mandatory for the clinical nurses to exercise due caution and care in pregnant patients. The after effect of anesthetic agents is known to pose serious health risk to the fetus. Therapeutic interventions for patients recovering from anesthesia: It is imperative for the healthcare providers to ensure that the most effective strategies are adopted so as to minimize the pain and suffering caused to the patient during surgery. There is a direct relationship between health and well-being of individuals and their surrounding environment. It has long been established that the physical environment of the individuals directly affects their health. Studies have indicated that people with access to clean, hygienic and positive environment are likely to recover faster as compared to those devoid of it (Purves, 2012; Dendaas, 2009). As a response to the growing body of evidence suggesting the discomfort experienced by patients after surgery, various therapeutic intervention methods have been introduced over the years. This includes music therapy, hypnosis, or hypnotherapeutic techniques, massage therapy, meditation, nutrition and herb counseling, fitness programs, as well as various other mind-body relaxation techniques. Some of them are discussed below: Music therapy: There is ample evidence which indicates the significance and role of music therapy in influencing positive health among the patients. Research suggests that music therapy is known to effectively reduce anxiety, and normalize the hemodynamic parameters thus resulting in speedier recovery of the patients by drastically improving their post surgical outcomes (Schneider et al., 2001; Szeto and Yung, 1999). Music helps in generating positive emotional responses among the patient. Studies surrounding psychoneroimmunology indicate that the positive emotional responses on the part of the patient directly results in influencing the immunological functioning which in turn helps in reducing feelings of anxiety and stress, thus negating the impact of surgery on the body's immune system (Malkin, 2003). Music therapy helps in pain management. According to Davis and Srivastava (2003) poorly managed pain drastically increases the risk of depression and mood disturbances among the patients. The application of music therapy as a rehabilitative or therapeutic intervention hence helps in preventing negative social experiences for the patients and helps in easing their pain (Koestler and Myers, 2002). Music therapy is described as a non-invasive nursing intervention which helps in immediately restoring the pulse beats of the humans and normalizes the respiratory system, blood pressure, as well as the metabolic rate (Chlan, 2000). However it must be noted that not all types of music have positive health benefits for the patients. Only soothing and refreshing music is known to have a calming effect on the patients. Hence the recovery nurses must ensure that the appropriate type of music therapy is chosen in accordance with the background of the patients in order to derive optimum positive health outcomes. Hypnosis: The impact of hypnosis as an effective therapeutic intervention technique has been widely discussed and debated by researchers. According to a study conducted by Enqvist et al (1997) on the impact of hypnosis on a group of female patients undergoing breast surgery it was observed that those who were exposed to hypnosis therapy experienced lesser pain and were highly successful in avoiding the negative post-operative repercussions of anesthesia and surgery i.e. vomiting and nausea. The women who were provided hypnosis treatment also indicated lesser need for analgestic medication in the post operative period as compared to those who were not given any such therapeutic intervention. Aromatherapy: Research indicates that healing is accelerated by application of therapeutic intervention techniques which are aimed at appealing to the human sense of smell. Aromatherapy - which entails use of oils used for healing purposes, have been practiced across various parts of the globe as a key healing technique (Buckle, 2001). Aromatherapy is also widely popular for healing various types of skin conditions, wounds, as well as for relieving pain and anxiety among the patients (Wheeler-Robins, 1999). Aromatheraphy is identified and acknowledged by various studies as a perfect cure for dealing with postoperative nausea and vomiting which is normally experienced by surgical patients. Nausea and vomiting are the negative effects of anesthesia and surgery and the use of enriching oils which appeals to the sense of smell of the patients help them ease the pain and reduce the feelings of nausea (Collins, 2009; Wilhelm, Dehoorne-Smith, Kale-Pradhan, 2007). Conclusion: Regardless of the immense advances in medical technology and introduction of innovative healing techniques, surgical patients still need active assistance and support of the recovery nurses to combat the negative effects of anesthesia and surgery and to help relieve pain in the most effective manner possible. The clinical, therapeutic, as well as non-pharmacological intervention techniques adopted by the recovery nurses helps immensely in generating a positive health outcome for the patients and helps relieve pain to a considerable extent. Most patients are highly concerned regarding the degree of pain and suffering they are likely to experience post the surgery and anesthesia. Perianesthesia nursing can play a key role in helping the patients overcome their painful discomfort and pave way for a speedier recovery. Patient satisfaction after surgery and anesthesia is one of the key contributory factors of an effective healthcare management and patient care. Skilled nursing management directed at patients recovering from anesthesia, significantly increases the likelihood of speedier and effective recovery of the patients. References: Chlan, L., (2000). Music therapy as a nursing intervention for patients supported by mechanical ventilation. AACN Clinical Issues Advanced Practice in Acute Critical Care, Vol. 11 (1): p. 128-138 Collins, B., (2009). Postoperative nausea and vomiting in adults. Association of PeriOperative Nurses. Vol. 90 (3): p. 391-413 Cote, C. J., Lerman, J., Todresm I. D., (2009). A practice of anesthesia for infants and children. Elsevier Health Science Publication. County, B., (2004). Advancing perioperative practice. 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