Day Surgery and Surgery Reflection - Essay Example

Day Surgery and Surgery reflection 21205821 Introduction Surgical procedures are usually regarded as one of the most complex health care service provision by many healthcare practitioners (Pinney, 2000). Research has indicated that there are varying surgical procedures that require different techniques to effectively perform. However, some of these procedures have exhibited relative similarities in the manner through, which they are undertaken or performed. In addition, some surgical procedures may require a patient to remain in the hospital, specifically in the recovery room for an extended period of time, while others are simply performed and the patient discharged on the same day of the surgery (Pinney, 2000). This discussion will focus on two parts based on a personal reflection of two different surgical procedures that were carried on two different clients. The first part of this essay shall focus on a reflection about a gamma nailing surgical procedure that was performed on a 46 year old, patient, Mr. Smith. His surgical procedure shall also be compared to another 2 groups of patients; pediatrics and elderly that were performed in the same health facility. However, all the discussions shall be guided by the Disc roll Framework through the what, so what and the now what. The second section of this reflective essay, which shall also be described through the What, So What and the Now What, shall focus on a Day Surgery on a 26 year old, Mr. James who had undergone a left Inguinal Hernia surgical procedure. To maintain the anonymity , the names Mr. Smith and Mr. James were given in compliance with Health and care profession council; Standard for Conduct, Performance and Ethic. Part One Gamma Nailing Surgery What It was a chilly Tuesday morning. I arrived at work at 7.30am. I rushed to the changing room to change into my assigned theatre scrub suit. I was preparing for the long day’s work at the operation room. I had been assigned to theatre 3, which is the emergency theatre. There were four patients on the operation list. I began undertaking routine checks as I was to act as a scrub practitioner for the first patient on the operation list. His name was Mr. Smith, 46 year old, who had to undergo a Gamma Nailing surgery. He had suffered a car accident the previous night and his case was considered an emergency: Thus, his name was the first on the list of patients to be operated that day. Gamma Nail has been used for a long time in medical practice. The gamma 3 locking nail system is the third generation of intramedullary short and long gamma fixation nails. This procedure stabilizes severe fractures on the femur using a metal road and screws inserted on the center of the bone. I began undertaking actions geared towards ensuring that everything was in order. I entered the theatre room to confirm that everything was ready. The theatre temperature was lower than it should be, then I changed to 23 degree Celsius. The air flow and laminate flow were in order; I raised the humidity from 43 to 50. I checked the operating lights and made sure the operating table was fully charged, its breaks were perfectly working and the attachments were in good condition. The next check I undertook was to ensure that all the instruments for the procedure were ready and that the sizes of the nails, drills and screws were of the recommended standards. Later on, I began a scrub up for the procedure; the circulating person gave me access to all the instruments that were required for the procedure and we did a count of all of them together with the swabs and the sharps: The data was recorded on a board. After all the preparation, and after the patient was placed on operating table, I crossed checked the WHO checklist to make sure that everything we had done was in accordance to its stipulations. The circulating person also made sure that I went through the consent form to verify whether the patient and the surgeon had appended their signatures. The procedure began, the surgeon began by preparing the skin, specifically around the region that was to be operated using alcoholic betadine. I had a responsibility of passing instruments step by step as the surgery process went on. The surgeon inserted a self-retaining retractor; I then attached necessary connections including the light handle, monopolar and suction tubing. The cannulated curved Awl was used to prepare the medullary canal ahead of reaming. The surgeon measured the size of the nailing and asked for 8mm by 230 mm nailing. Throughout the process of the surgery, we kept using x-ray to make sure that the nailing was moving towards the right direction. In collaboration with the surgeon, we undertook a second count and the surgeon asked for a skin staple together with a me pore dressing. I ensured that the region was clean before we performed the dressing process; this was followed by our last count of the instruments, sharps and the swabs. The count was correct. The procedure was successfully complete; however, before we took the patient to the recovery room, we recorded the surgery name; the amount of blood lost and completed all the requirements that had to be followed during the recovery process. So What Medical evidence indicates that the operating temperature in a theatre should be 23 degree (Brady & McCabe, 2013); however, in the case that we could have been dealing with a pediatric patient, the temperature could have been adjusted to 25 degrees. This is due to the fact that when performing surgeries on children, warmer temperatures are usually given a high level of preference: Children, infants and adolescents are prone to suffer from heat loss, thus require operating temperatures that are relatively higher than adults (Brady & McCabe, 2013). On the other hand, elderly patients are prone to suffer from cardiac morbidity; this can only be prevented through maintaining normothermia, which is normal room temperature of 24 degrees (Brady & McCabe, 2013). In addition, there are incidences of conflicts that may occur after the surgical procedure, majority of these conflicts are caused by patients that feel unsatisfied with the surgeon’s work or even due to complications that may occur afterwards (Wicker & Neill, 2010). However, such conflicts can also be prevented or avoided by signing consent forms by the patients, followed by surgeons (Wicker & Neill, 2010). In the case that the patient is a child, the consent of the parents or the guardians can be sought. With an elderly patient, research indicates that they may not be in a state of normal mental functionality or confused and thus the consent of their closest relatives should be sought (Wicker & Neill, 2010). The World Health Organization (WHO) provides a checklist for surgical practices in the whole world. According to the National Patient Safety Agency, the surgical safety checklist provided by the world health organization is an imperative tool for clinical teams to improve safety measures during surgery processes and avoid incidences of complication and loss of lives. In addition, the use of alcoholic betadine in orthopedic cases is crucial owing to the fact that it used to clean the surface of the skin, specifically the area to be operated: It removes any skin disease causing pathogens (Al Benna, 2012). However, the selection of an alcoholic based disinfectant over aqueous-based solutions is based on the fact that; they are quick, durable, sustained and with a broad-based spectrum of anti-microbial strength as compared to the aqueous –based (Al Benna, 2012). In the case that the patient is a child, the use of an aqueous-based agent containing chlorhexidine is considered; this is because they may not pose any negative effect on the skin of a child, which is considered biologically more fragile than an adult’s skin (Al Benna, 2012). The same case of a child would apply to an elderly patient. Owing to the fact that Mr. Smith was a 46 year old patient, we decided to use 8mm by 230 mm nailing, which is the recommended size for adult patients. However, in the case that the patient was an infant, the surgery would have involved the use of flexible nailing. This is recommended in that children tend to have softer and tender bones as compared to adults (Brady & McCabe, 2013). On the other hand, elderly patients would have involved the use of smaller sized nailing but, almost the same size as the adults’ sizes: This is based on the fact that elderly patients tend to suffer from bone fractures (Pinney, 2000). Some researchers have argued that effective communication is crucial in the theatre rooms (Hienerbaga & Meyer, 2009). This facilitates the interaction between surgeons, nurses and even the manner through, which they respond to the needs of their patients. Effective Communication also enhances the activities of the surgeons in the operation rooms as they facilitate the reduction of complications and errors that may be made due to poor communication (Hienerbaga & Meyer, 2009). Scrub practitioners play crucial roles on the Operating Tables. The scrub practitioners usually work in accordance to the aseptic technique; just like the surgeons, the scrub practitioners wear sterilized gowns, masks, gloves as well as face masks. Specifically, the responsibility of the scrub practitioner is to ensure the safety of the patient, surgeons and other personnel that may be at the table (National Association of Theatre Nursing, 2003). This responsibility is usually undertaken through sterilizing surgical equipments. In addition, the scrub practitioner is responsible for taking into account disposables for instance: Sharps, surgical equipment and even swabs. On the other hand, scrub practitioners have a great understanding of each surgical step and are responsible for passing and retrieving equipment to and from the surgical table (Hamlin, Richardson-Tech & Davies, 2009). In some cases, he/she may be responsible for safe collection of samples from the patient for laboratory tests. Medical experts have asserted that the process of undertaking surgical counts is important before and after operations (Brady & McCabe, 2013). Swabs, sharps and other instruments used to perform invasive surgical procedures should always be taken into account owing to the fact that they are foreign materials that may cause injury to the patient when left in the patient’s body (National Association of Theatre Nursing, 2003). In this regard, there are three major counts that are usually made during the operation. The first count is usually made a few minutes prior to the operation, the second count made before surgical cavity is closed and the last count immediately after the closure of the surgical cavity (National Association of Theatre Nursing, 2003). The use of skin staples for closure of wound has also been proved to be efficient for adult patients as well as elderly patients (Pudner, 2005). This is majorly due to the fact that they may not cause complications as in the case of pediatrics, which should involve the use of absorbable suture basically because the softer tissues that composes the skin of children . Moreover, the use of me pore for dressing wound is recommended among adult patients: This is majorly because of its absorbent, self-adhering and breathable nature that prevents the wound from contamination and water molecules (Pinney, 2000). However, for pediatric cases, the use of melonin would have been preferable owing to the fact that they do not only protect the skin from contamination, but also facilitates healing. With elderly patients, research indicates that jelonet should be used before dressing the surgical wounds because it soothes wounds, allows proper movement of viscous exudates and protects the wound (Brady & McCabe, 2013). The entire surgical process went on well and every instrument used was effective and efficient. The communication process between the surgeon and I was perfect. Now What The surgical procedure was successful; however, it is evident that the current methods applied to perform surgical procedures keep changing from time to time majorly due to technological advancement. In this regard, as a skilled medical practitioner, I find it imperative to keep updating my knowledge and information regarding surgical procedures and instruments used in the operational theatres. I will ensure that I read relevant medical materials of current surgical issues i.e. magazines, journals and other publications in order to ensure that my surgical knowledge is updated accordingly. In addition, I would update my communication skills, specifically those that are crucial during a surgical process and ensure that the knowledge gained is properly applied in future surgical procedures. Furthermore, I learnt that establishing a proper rapport with the patient forms an important channel of success during the surgical procedures. In this regard, I will keep updating my inter-personal skills and how I can effectively apply them in the future. Moreover, I will assess ways through, which I can psychologically motivate patients scheduled for surgical procedures. I would like to recommend this to other medical practitioners; it is an imperative aspect of any surgical procedure and plays a significant role in a patient’s recovery process. Part Two Day Surgery What It was a cold Friday morning; I was allocated a duty at the Day Surgery Unit specifically to look after Mr. James, a 26 year old who had to undergo a left Inguinal Hernia Surgery; he was among the three patients I was to take care of. I had met him about two weeks ago in the pre-assessment clinic where: I had to assess his medical conditions specifically; assess his overall medical conditions and educate him on issues ascribed to risks that could occur during the medical procedure. During the pre-assessment clinic, Mr. James was exposed to a thorough assessment procedure that also focused on identification of risks that could affect his recovery .plan. I did his base line observation in that time, which was Blood Pressure 124/72, oxygen saturation99%, heart rate 64, height 176cm and weight 70 kg. Then I calculated BMI (22, 41). A full blood count, urea and electrolytes urine analysis was done and results were normal In addition, I examined the extent of his disease. Consequently, I made sure that I established a proper rapport with the Mr. James during the pre-assessment period so that I could identify his fears and other challenges he thought he could face during the operation period. This ensured that any question he raised was answered properly to give him psychological encouragement and as a means to assure him of the success of the surgery. I began with the pre-op preparation of Mr. James, by first checking his blood sugar and ensuring that his medication as a diabetic individual could not affect the success of the operation. I had been informed that he was classified as an ASA 2 owing to the fact that he was diabetic and was on medication thus checking his blood sugar. I sent him to take an ECG test on him owing to the fact that his blood pressure was 172/68. All these procedures were geared towards ensuring that Mr. James was fit for the surgery. After the ECG, his blood pressure was at 132/65, which was a relatively recommended level for the surgery. I asked him if there was any change with his medication and inquired if there was any change with the person, who would pick him after the surgery in this interval of 2 weeks since we met in pre-assessment. After checking all these, Mr. James was ready for the operation. I recorded all the observations. Three hours later I went to the recovery room where he had been taken after the surgery. I brought him back to the ward and I began the post op observations. I immediately connected the pulse oximeter and blood pressure cuff and I start recording all the post-op observations, these observations were done on 15 minutes interval. The blood sugar was 5.8. I kept on checking the sides of the wound to ensure that it remained clean and dry. He complained that he was feeling sickly and I gave him 50mg of cyclizing as he had 4mg of ondansetron during surgery. I then asses his pain level and he gave me a score of 2 out of 10. I decided to administrate 50 mg of tramadol, sips of water and I left him to rest for a while. After he had a light meal and he passed urine I prepared his discharge by making sure all the necessary documents are signed in accordance to the guideline provided. Before he went home, Mr. James appeared well as bright, the pain level was 0, he was breathing spontaneously, blood pressure was normal, oxygen saturation was 100% and he was fully aware of what was going on. However due to the fact that he was feeling sickly earlier on, I called his brother to witness the signing of the necessary discharge documents. So What Medical documents indicate that Inguinal Hernia operation is a minor operation that does not require a patient to spend extended periods of time in theatres for surgery (Nestel & Kidd, 2006). In this regard, one can undergo an inguinal hernia operation within a period of three to four hours and discharged the same day to go home. However, it has been asserted that patients that have undergone such kind of operation should be in a position to organize so that somebody drives them home later in the day (The National Association of Nursing Theatre, 2003). The procedures of sending patients to have an ECG check before and after a surgical process has also been termed as crucial for the success of the surgery and their recovery processes (Nestel & Kidd, 2006). To begin with, this process facilitates the checking of electrical activities of a patient’s heart so that any complications that may arise is identified and prevented (Bingham, Lloyd-Thomas & Sury, 2008). In addition, electrocardiogram allows health care practitioners to check whether medications that patients have been using have negative effects on his heart; this ensures that further complications through medication or through the surgery are avoided (Bingham, Lloyd-Thomas & Sury, 2008). On the other hand, ECG tests ensure that the health of a client’s heart with regard to blood sugar, blood pressure is checked and any complications that may arise are prevented (Pinney, 2000). According to the National Association of Nursing Theatres 2003, there are cases where conflicts may arise after the discharge of a patient from an operating room especially when certain complications occur. Some of these complications may be as a result of the surgery, but some of them may not; in this regard, it is crucial that all the guidelines of the surgical process are followed to the latter, and all necessary documents are signed by the concerned stakeholders. In the case that a patient is not in a position to sign such documents, either because he is sickly or because he is elderly, a witness, majorly a close relative of the patient may be called to sign the documents. In a research article published by the Association of Preoperative Practice 2007, it is indicated that patients undergoing day surgery may experience feelings of nausea or even sickly majorly due to the stress ascribed to the surgery process. In such cases, patients may be provided with certain medication i.e. cyclizin to improve their condition just before discharge (The National Association of Nursing Theatre, 2003). On the other hand, patients undergoing inguinal hernia operation should be subjected to checks, specifically focusing on the manner through, which they excrete wastes such as urine or even sweat (Bingham, Lloyd-Thomas & Sury, 2008). This is due to the fact that such patients may have challenges with taking liquid products and even excretion. Pain management is one of the vital discharge criteria. In case of my patient Mr. James, 50 mg of tramadol was administrated to reduce the pain. This drug is recommended in Day Surgery due to its fewer causes of sedation and respiratory depression. Rawa et al (2001) describes tramadol as a weak opioids agonist which reduce serotonium and non-epinephrine in patients. Another criteria patients should meet prior to discharge is a minimal of nausea and vomiting. Therefore, anti-emetic such as cyclizin acts by blocking H1receptors in CT2 and labyrinthine apparatus, (Carlise et al 2006) In addition, research indicates that all surgical procedures require a high level of cooperation between the patient and the medical health practitioners (Bingham, Lloyd-Thomas & Sury, 2008). It was therefore my duty as a practitioner who had to participate in Mr. James’ day surgery room to establish a proper rapport with him so that his fears regarding the surgery and any questions could be handled properly. In addition, medical evidence has indicated that surgical pre-assessment is an imperative process that ensures that risks that may occur during the process are prevented or avoided (Bingham, Lloyd-Thomas & Sury, 2008). It ensures that a patient’s medical history i.e. blood pressure, blood sugar levels and other health conditions are taken into consideration to ensure that they do not facilitate the occurrence of complication during the surgery process. As a practitioner, it was my responsibility to ensure that Mr. James was psychologically prepared for the procedure; medical records indicate that the psychological conditions of patients undergoing surgery are pertinent not only during the surgical process, but also during the recovery period. When I allowed Mr. James to dress up, he did so comfortable with minimal assistance of his brother, I explained that was crucial that he keeps his wound dry up to 24 hours before changing daily after bath. I also informed him to maintain his personal hygiene, eat appropriately and walk regularly to help him to return to better shape. It is imperative that patients are well informed of the effect of anesthesia on their activities as well as conceivable complication (Departament of health, 2002) On the other hand, there are certain factors taking into consideration after a patient has recovered from a day surgical process (Domingo et al, 2000). One of these factors is the capability of patient to ingest food normally, breathing rate and even the manner through, which the patient excretes wastes such as urine or even sweat (Domingo et al, 2000). As a practitioner, I had to ensure that these biological processes are checked so that any complication that may arise is corrected before the patient is discharged. Moreover, I had to send Mr. James back to the ECG; this is usually a recommended procedure after every day surgical procedure. It is important owing to the fact that it ensures that the blood sugar levels, blood pressure and the breathing rates are checked and corrected in the case that any abnormality is identified. The last step, which is recommended in almost all surgical guidelines in appending signatures in the necessary documents (Association for Preoperative Processes, 2007); I had to ensure that the patient signed all the necessary documents to avoid future conflicts and also append my signature. Developing a proper rapport with a patient before the surgical procedure is an imperative psyco-medical facet. It does not only increase a patient’s confidence in the surgical procedure, but also enhances their recovery process. Therefore, it is appropriate for practitioner to engage with their patients through voluntary discussions to educate them on issues ascribed to the planned surgical procedures and even answer questions that they may have. In addition, day surgical medical health practitioners should ensure that certain parameter/guidelines of day surgical operations are taken into consideration for instance: Checking a patient’s health conditions a few hours before the surgical procedure is of great importance. Therefore, discharging a patient requires some preparation, assessment and educating patient with necessary information, (Gilmartin 2007) Now What Based on my placement experienced, I felt that this empowered me to integrate the analysis of any research embarked on with direct reflection on practice Pre-assessing and discharging Mr. James was challenging because it was my first time to take a lead Additionally, throughout the essay, I have endeavored to express my understanding in exploring the role of care giver and practitioner as far as clinical intervention. Conclusion From the two surgical procedures, there are crucial observations that I made. To begin with, there are specific guidelines that have to be taken into consideration before the surgical procedure, during the process as well as after the process. In addition, surgical processes require a great sense of collaboration cooperation between the medical health practitioners and the patient. This is an important factor for preventing conflicts that may occur in future or even complications that may arise during the surgical process. Having been able to anticipate with surgeon by passing instruments in a correct manner and passing appropriate sutures and wound dressings was a great achievement for me. Another important observation that I made during the procedure is that cleanliness, specifically of the surgical wounds and the surgical equipment is crucial. In conclusion, caring for patients in pre-assessment and discharge should be centered on the patient well-being Reference Aitkenhead,A. R., Rowbotham,D.J. and Smith,G.2007.Textbook of anaesthesia 5th ed. Edinburgh: Churchill Livingstone Al benna, S.2012. Infection control in operating theatre. 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