Post-Anesthetic Nursing and Professionalism - Essay Example

Post-operative care Post Anesthetic Nursing and professionalism A profession is a special body of knowledge acquired through a period of time with dedicated training. The each profession has specific issues of concern and also the rules and regulations defining its area of interest. The Patients who have undergone surgery require close monitoring and professional nursing care. It is necessary that all standards of care be followed strictly and without compromise for an impressive patient outcome. It is the duty of the surgical team together with the circulating nurse to ensure that the patient is assessed by checking on the condition. Usually the patient should be stable during transfer to the recovery room. The anaethetist should ascertain that the recovery team is reliable and competent enough to care for the patient. The ethical principles ensure that the patient receives the best of care and no harm is done to him or her. Many complications can arise due to anaesthesia. Various body systems such as the respiratory and circulatory systems are affected. These can lead to a poor outcome of the surgery performed and prolonged hospitalization of the patient. Relentless observations and total patient care is of importance to avert possible complications1. Current challenges on Recovery Room Many patients from the theatre require total nursing care and this implies that the nurse has to be available 24 hours and be observant as well. Since the spontaneous breathing is compromise, the patient has to be put on a mechanical ventilator with the arterial blood gases being check to determine possible hypoxemia or oxy gen poisoning. This however poses a challenge due to either failure of the machines that are also expensive to maintain and acquire as well as the nurse experiences burn out2. Shortage of supplies such as drugs, suction tubes, syringes, and dressings make it difficult for nurses to work in the Post Anaesthesia Care Unit (PACU). This also makes the duty of collecting and ensuring that supplies are available difficult. The nurse spends more time looking for supplies instead of taking care of the patient. Vital observations and assessments can easily be missed out. As a result, patient care is compromised3. Lack of biomedical engineering skills among nurses makes it hard to make early detection of machine failures and consequently delayed repair of medical equipment. Since nurses operate equipment such as suction machine and defibrillators, they should have enough knowledge on the normal functioning of the machines and their commonly encountered problems. Unconscious and disoriented patient require safety from injuries due to falling and self-harm. This is the duty of the nurse to ensure protection through nursing the patient in a bed with side rails. The nurse should provide pressure area care is turning the patient 2hourly to prevent pressure sores. The lower extremities should be checked for deep venous thrombosis that can result due to venous stasis precipitated by immobility. However, absence of appropriate beds and the increased number of post-operative patients strain the nurses. Safety of the patient is adversely affected as the nurses are easily fatigued and patients may fall off easily since they are not protected from the sides. Poor positioning of patients limit adequate lung expansion and it can lead to poor venous return. Conditions such as asthma and bronchiectasis mostly complicate in anaesthesia. The effects will also interfere with the recovery of the patient after surgery. This means that the patient has to be put on continuous ventilation for oxygenation, administration of bronchodilators and antihistamines to enhance upper airway patency and reduce the inflammatory process respectively. The stay of the patient in the recovery room is thus prolonged4. The patient is discharged into the surgical ward after the vital signs (temperature, blood pressure, pulse rate, and respirations) have stabilized. The recovery nurse should assess the capability of the surgical ward nurse to care for the patient as required. The anaesthetic gases must be fully cleared from the patient respiratory system through exhalation. The bed in the surgical ward is to be prepared in advance for the reception of the patient from the recovery room. Factors such as increased trauma patient number in the surgical ward and disorganization occasioned by inadequate communication leads to lengthy stay of the patient in the recovery room. To prevent this from happening, a bed should be reserved in the surgical ward for any patient entering the recovery room. More space and beds have to be provided to cater for the increasing number of surgical patients. Technology has brought about new and advanced equipment. The nurses have to find time and update themselves to familiarize with the technological changes. This tasks them heavily considering their demanding work in the ward. Anaesthetic agents are changing too and conforming to the requirements is significant to understanding their pharmacokinetics and effects to the patient. Post anaesthesia complications such as nausea, excessive pain and vomiting, hypoxaemic episodes and hypoventilation prolong the stay of the patient in the recovery room. This increases the expenses of caring for the patient. Ultimately, the cost of running the recovery room escalates. A lot of resources and time are required to provide care for the post-operative patients5. Extended role of recovery nurse The nurse in the recovery room provides holistic care to the patient. All the needs of the patient are fully met through a holistic approach of care. A thorough needs assessment is done to help in prioritizing patient care. It is important that care provided to the patient be personalized since patients’ needs differ. The patient is put on parenteral feed before the bowel sounds are established. Thereafter, the patient is put on fluid meals per oral with the recording of input and output on the chart. A balanced diet rich in proteins and fluids is given. Good nutrition prompts faster wound healing and development of a strong immune system6. Hospitalizations of the patient after surgery is an issue of concern to the significant others. The nurse plays a key role of providing useful and factual information on the progress of the patient. He or she also responds to questions asked and provides assurance. It is also the duty of the nurse to report any abnormal findings about the patient’s behavior. This is necessary for an appropriate action to be taken. Further patient examination is also prompted. The nurse also clears and cleans the recovery room for the next patient by decarbonizing the bed and providing required supplies. The room is kept clean and well ventilated with enough warmth providing a conducive environment for the patient from theatre. The patient records are updated for proper documentation and continuity of patient care and record keeping. This will ensure that the ordered patient care is accomplished. Endotracheal intubation is performed for patients experiencing respiratory insufficiency and hypoxia. Intubation serves to keep the airway patent, to limit upper airway obstruction, to prevent aspiration of gastric content, for suctioning of secretions and to allow resuscitative bagging of oxygen. Most of critically ill patient require intubation to facilitate oxygenation via a mechanical ventilator. The recovery room nurse is equipped with skills and knowledge to provide care. In the case where the critically ill-intubated patient is nursed in a general ward the recovery room nurse will still care for the patient His or her duties will be to provide artificial humidification and suctioning of secretion due to reduced cough reflex. Continuous positive airway pressure will lower the risk of atelectasis. The nurse monitors the vital signs noting the abnormalities such as elevated temperatures and drastic changes in pulse rate and blood pressure. Administration of intravenous fluids will improve the haemodynamic volume enhancing stability and restoring electrolyte imbalances. The patient is put on parenteral feeds due to impaired gag reflex. The recovery nurse calculates the parenteral feeds basing on the patient nutritional status. The infusion of feeds is regulated to avoid overloading the patient. Regardless of the extended role of the recovery ward nurse in the general ward, he or she must observe the authority and management roles. The nurse should work under the supervision of the ward in charge. Clear and comprehensive records of patient care must be provided to ensure that care provided is accounted for. Safety measures for the patient in recovery room The environment is a key factor in ensuring that the patient is safe. The patient’s immediate environment is the bed. The bed should have side rails to prevent the patient from falling. The bed sheets should be free of food crumps, dry and clean to prevent the patient skin from peeling due to abrasion and friction. Care is also provided for patients with bowel and bladder incontinence7. The patient should be nursed is a position appropriate to the type of surgery performed. Special considerations should be given to lung expansion and venous return. Anticoagulants should be administered to prevent formation of thrombi that can lodge in the main blood vessels and lungs8. Patient safety is also enhanced by administering the right drug dosage to the right patient by the right route and at the right time. All intervention performed must be documented to avoid duplication of duty and medical errors such as repeating a drug administration. Visitors should be controlled to avoid overcrowding around the patient and causing possible infection transmission. The impaired skin integrity is a risk for infection and the nurse should ensure the environment is clean the wound dressed to avoid exposure. Prophylactic antibacterial therapy is initiated to protect the patient from acquiring infections9. Discharging the patient The patient from the recovery room can be discharged directly either home or into the surgical ward. The physiological status and the type of surgery determine where the patient is discharged. Several parameters should be used to during the discharge of the patient. The patient should be conscious with normal functioning stimuli response, well established cough reflex to clear the airway and normal inhalation and exhalation rhythms. The arterial blood gases should give satisfactory readings with the patient exhibiting good oxygenation. The pulse oxymeter is used for accurate findings. The electrocardiogram reading should show normal cardiac function. Unexpected and unabated hemorrhage should be absent. The blood pressure, the pulse rate should be within the normal values or those obtained as base values before surgery. The patient should report minimal or no pain before discharging. The pain assessment scales such as the scale of 1­-10 is used to rate pain. Analgesics should be administered according to the degree of pain experienced. Strong analgesics such as morphine used for severe pain. Patient’s comfort is enhanced when pain is managed10. Emesis should be controlled through administering appropriate antiemetic drugs to prevent dehydration and aspiration of food content. The temperature readings should be within normal (35.5-37.5 degrees Celsius). This helps prevent hypothermia. Extremities are examined to determine adequate blood supply and venous return. If the patient is being discharged to a general ward, prescribed oxygen and intravenous therapy should be documented in the patient’s file. In addition, if the patient is being discharged home required health education should be given and the patient understanding determined. The level of activity of the patient should be satisfactory. The patient should move all extremities on command and appropriately just as before the perioperative state. This gives information if the patient is ready to perform activities of daily living and ambulation. The incision site should be clean without fresh blood discharge and no signs infection. Swelling and offensive odour is a sign of inflammation and infection. The patient should be able to flex the knees and elevate the buttocks if he or she received spinal or epidural anesthesia11. The nurse must have confirmed that the patient is able to sit upright without complicating to orthostatic hypotension as an effect of anaesthesia. It must be mandatory that the relative using an appropriate means of transport escort the discharged patient home. The patient being discharged home must have prescribed drugs, fully informed on the dosage and side effects. The requirements will ensure that the patient receives appropriate continuous care to facilitate quick recuperation. This is attained through a full physical examination and a comprehensive recoding done by the recovery nurse. Ethics and accountability Professions are governed by rules and regulations. Particularly the perioperative care is strengthened by rules and regulations that ensure quality health care. All patients undergoing surgery are entitled to proper care regardless of age gender and age12. Various principles of care are observed to attain the desired care. Duty of care This is a worldwide basic requirement for all practitioners of health care. The perioperative nurse is charged with responsibility of providing required care to the patient without omitting any step or adding in unnecessary interventions that can harm the patient. The nurse practitioner should win the trust of the patient by maintaining his or her dignity through providing individualized care and addressing patient concerns swiftly. Duty of care is demonstrated when the nurse facilitates a safe environment for the patient. Care is also extended when the nurse administers required medications to the patient to relieve pain and prevent complications associated with anaesthesia. Patients on mechanical ventilators and ECG machines require close monitoring throughout their stay in the recovery room. It is the duty of the recovery room nurse to ensure care is accorded to these patients13. Comprehensive reports must be provided during handing over of the patient at the end of shift. This should detail all the interventions done to the patient and those to be done. The patient condition and response to care is also captured in documentation. Special findings that can help improve patient care are also availed. Nurses are supposed to be effectively trained and competent to avoid making professional errors that can cause harm to the patient at any stage of care. Continuing education is recommended for the nurses to keep updated of the increasing demands on their duty of care14. The main challenge is encountered when the patient refuses to consent for care. The institution is held responsible for poor prognosis by the fact that it accepted to admit the patient. Little can be done to provide care for a patient who is uncooperative regardless of patient’s knowledge on the implication of lack of treatment. Standard of care Once the perioperative nurse understands his or her duty of care, it is also important that the level of performance of duty be established. The required skills and interventions must be guided by the provided standards of care. Procedure manuals and protocols are of utmost importance in ensuring that the level of care provided is of high quality as per the institution policy. The patient should be well informed and consent signed on paper before any procedure is done. This will ensure that the patient understands why a certain procedure is done and aware of the possible risks that can occur highly skilled and competent practitioners to avoid injury to the patient and procedural omissions must do .The technical procedures. This protects the institution from being sued due to poor standards of care15. Infection prevention and control must be observed to prevent the patient from nosocomial infection. The perioperative health practitioner observes aseptic technique in caring for the patient. The patient’s environment should be kept clean warm and free from air disturbances. There exist varied policies concerning the standard of care in different health institutions. This can infringe on the standards of care provided in recovery room, as practitioners are obliged to adhere to the policies providing substandard care16. Professional Accountability The perioperative nurse should account for all interventions and duties performed with the interest of meeting patient care. The nurse is held responsible for every action done whether delegated or direct duty. This keeps the nurses on toes to upholding the reputation of their profession all through their practice The nurse is required to act immediately in the case of impeding risk to the patient. It is also the responsibility of the nurse to be vigilant to the safety of the patient by assessing and recording problems in the environment. The patient’s records must be kept unaltered in their initial state for accuracy and accountability purpose17. The health practitioner is required to justify his or her action by citing the standards of care observed during provision of care. Documentation is compulsory for continuous patient care and for evidence-based practice. All care delivered must be based on the suitable level of practice required for quality health care. It is necessary that the nurse understands and works within the required limits of competence. Interest should focus towards increasing the fund of knowledge and skills to fit effectively the changing trends in the medical field. Delegation of duty The duty to care for the patient is continuous and is facilitated by proper handing over of the patient to the next qualified nurse practitioner. Despite the fact that the primary health provider is held, answerable to the health care outcome, the accountability and responsibility of care provided must not be compromised. The nurse who receives the authority to care for the patient must adhere to the standards of care through effective completion of task assigned. Before delegation, it is important that anyone who receives the responsibility is capable of performing the required duty effectively. Work delegated must be supervised to enhance adherence to performance standards and instructions provided. The delegate must receive adequate support to provide smoothly the care to the patient. The scope of practice The roles of the perioperative practice are clearly defined and it is the requirement that each practitioner is well vast with the duties and responsibilities. Moreover, consequences related to failure to observe the scope of practice. It is a requirement that the practitioners protect the interests of the client during care and always. The practitioners become competent through continuous acquisition of skills and knowledge of the new developments in their field of practice Duty assigned must appropriately delegate following required procedures and protocols. The current standards of care must not be adversely affected by the alterations and responsibilities within the scope of practice. Inadequacies in terms of knowledge and skills must be recognized and appropriate interventions taken to meet the gaps. Large fund of knowledge is imperative for successful practice in the perioperative field. Professional negligence Failure of the health care practitioner to follow the logical order in provision of health care can result to harm of the patient. The patient may be prompted to seek legal action against the practioners for negligence and by extension the institution. Once the patient has been admitted to the post-anesthesia care unit, the duty of care is automatically established. It is the prime responsibility for the nurse practitioner to provide patient care. Negligence is said to have occurred if the following elements ensue; the practioners owed the duty of care to the patient from the time of admission until discharge of the patient. The practitioner, the patient suffered adversely due to breach of duty, must have violated the standard of care. It should be confirmed that harm sustained by the patient was due to substandard care provided by the practitioner. Sufficient evidence of professional malpractice is needed for and individual practitioner to face full force of law. Recommendations Strategic planning is required to address challenges encountered in the recovery room. Necessary equipment and materials require must be made available and accessible. The maintenance and serviceability of the medical equipment helps in preventing machine failure during lifesaving procedures. The nurse must be trained to handle the equipment as well. The nurse must be well informed of her extended roles to give her enough time to plan on how to effectively carry out the task. This will help disorganization and provision of substandard care. Delays in preparing the patient’s bed are addressed by timely preparedness of the ward nurse. The reception of the patient from theatre must be easy with minimal difficulties. Safety of the patient is enhanced through environmental cleanliness and strict observation of infection prevention policies. Aseptic technique must be used whenever handling the patient. It should be made compulsory for all health practitioners to learn and understand the ethical principles. Consequences associated with malpractice must also be clearly defined and availed to all health care workers. Continuing education for all perioperative practioners is prolific in contributing to improved standard of care and adherence to professional ethics and norms. Further knowledge enhances adaptability to ever changing trends in medical field. Conclusion In summary, professional issues in perioperative practice elicit varied and mixed reactions basing on the implicated requirements on the practitioners. It is however paramount that patient care is provided in an environment cultured by effective policies and regulations without over burdening the health care practitioner. Both the patient and the health personnel must be protected from harm. The autonomy of the patient is enhanced through an enhanced ability of making well-informed choices basing on relevant information provided. The patient enjoys suitable available care through the collaborative effort of the health care provides. 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