This particular paper is focused on evaluating the evidence base of operative nursing care practice. The major aim of the paper is identifying the nature and current trends of care practice. Operative care is a very crucial practice which defines the recovery effectiveness of any individual patient. The effectiveness of successful operation is hugely dependent on a well planned operative care model. In this particular evaluative study, the paper has identified five major sub categories of opposite care practice in healthcare setting. The paper also focused on highlighting the efficiency parameters, current trends and recent amendments by evaluating the evidence base in these respective categories. It has been identified that there is no specific population age for operating nursing care. Whether, this particular care is provided every emergency situation irrespective of the patients age.
Operative nursing care includes three stage that are pre-operativenursing care, intra operative nursing care and post-operative nursing care. Evidence nursing practice is a control; measure in order to improve the nursing technique for well-being of patient.
Pre-operative nursing care
In the opinion of Wotmanet al. (2017), pre-operative nursing care is a treatment specialty that works with patients who are having operative or other intrusiveprocesses. It can be said that preoperative care is the management and preparation of a patient before surgery. It contains both physical and psychosomatic preparation.Besides any physical care, nurses are responsible to make the patient understand about surgical Moreover, pre-operative care includes many things that should be done before one day of operation or may be one week or one month of operation, whichdepends on the condition of the patient or terms and condition of the surgery.
Physical care may contain a wholetherapeutic history and physical test, containing the patient's operating and anesthesia conditional.The nurses should concern that whether patient has any adverse reaction or allergy from anesthesia or not. For example some patient may have anaphylactic shock in which patient can die if he or she exposed to something they have severe allergy. On the other hand, some patient also may have malignant hyperthermia, which may cause rapidly increase the body temperature and patient suffer from severe muscle contractions.
In the opinion of Zareiet al. (2018), before surgery in order to, examine the health condition of the patient several laboratory tests are being done such as complete blood count, activated partial thromboplastin time, electrolytes, urinalysis, prothrombin timeetc. Moreover, as opined byFenclet al. (2015),many other tests according to the patient’s condition should be done such as, Electrocardiogram test if patient has history of cardiacsyndrome, chest x-ray if patient has history of respiratory disorder etc. the nurses concern and keep in their mind about the entire report. Infection control is one of the efficient evidence based nursing practice. Nurses play a crucial role in serving to avoid illness before it occurs by following to evidence-based infection-control guidelines (White et al., 2016).
Moreover, many other things are there in which nurses are concerned about some risk factors that might damage curative process, such as dieteticinsufficiencies, radiation or chemotherapy, steroid use, drug or alcohol exploitation, or any metabolic sicknesses such as diabetes.In the similar context stated that Roveronet al. (2016), nurse should maintain entire list of medications, food supplement, vitamins that the patients use before and after the operation.
Trained nurses also manage not only the physical care but also psychological care. According to the previous research it is seen that maximum patient feel anxious and nervous before any surgery. This process is beneficial mainly for the patient who are severely ill and having high-risk operation procedure. Not only the patient but also their family is included in this psychological caring process. The treatment make them mentally strong prior to any surgical treatment. Patients who are prepared psychologically and physically for surgery have a tendency to have better surgical results.
As opined by Fenclet al. (2015),preoperative learning meets the patient's requirement for information concerning the operating experience, which in shot may ease most of his or her worries. According to the previous research, it was seen that patients who are well informed about what to suppose after operation, and who have a chance to express their aims and feelings, frequently handle better with postoperative discomfort and reduced mobility. In the opinion of Zhang et al. (2016), pre-operative attention is exceedingly essential prior to any intrusive procedure, irrespective of whether the process is minimally intrusive or a form of major operation. On the other hand, pre-operative care is different and it varies from man to man. Some individuals want as more information as probable, while some others favor only minimal knowledge because too much information may upsurge their nervousness. Nurses should aware of this.
Intra operative nursing care
Intra operative nursing care is dine during the time of operation. Several work is done by the nurseat the time of operation. In the opinion of Ahmed(2017), the main responsibility of intra operative nursing care may include observing patient’s vital symptoms, fluid therapy, blood oxygenation level, anesthesia, medication transfusion, recovering samples for laboratory tests, radiotherapy etc. Not only the nurses but also nurse deliver anesthetists intraoperative care, anesthesiologists, surgeon, surgical technicians, and residents all are involved in this process.
The main aim of the intraoperative care is to keep up patient security and comfort during operating processes. Some of the aims of intraoperative care consist of keep up homeostasis for the duration of the procedure, maintaining strict disinfectedmethods to reduce the chance of cross-infection, make sure that the patient is safe on the operating table, and taking methods to avoid hematomas from security strips. According to Zaccagnini and Pechacek (2019), previously sterilization was done by alcohol or boiling in water. Now days, following the evidence based nursing practice, sterilization is done through autoclave, ionization, chemical disinfectants etc. which improve the efficiency rate of nursing care.
According to evidence based nursing practice patients are given different types of anesthesia according to the need of the surgery at the time of operation. Anesthesia can decrease cardio vascular function or can increase cardiovascular irritability. Moreover,many other complications such as respiratory depression, paralysis, loss of awareness, loss of sensation may occur during the operation as because of anesthesia. It is the responsibility of nurses to make sure about the process and make aware of the patient’s physical and mental condition. Additionally, it is the responsibility of the nurses, who are working in the surgery room to maintain a definite count of all instruments, sponges and sharps that may developgerms and may be infected upon dissection closure (Rothrock, 2018).
At the intra operative stage, it is the duty of the nurse to informcontinuously about the condition of the patient to the doctors or surgeon. For example, blood pressure of the patient it may be high or low sometime, electrocardiogram report of the patient, any kind of respiratory imbalance,cardiac illness during the surgery etc. should be continuously informed by the nurse to the surgeons in the operation theatre. For patient health and security, it is necessary that nurses monitor evidence-based practice in nursing when it arises to provide oxygen to COPD patient (White et al., 2016).
There are different type of work for nurses in order to take care of a pre-operative nursing patient such as circulating nursing, instrument nursing, perianesthesia nursing, RN first assistance etc. The circulating nurse helps in dealing the nursing care of a patient during operation. In the opinion of Modesittet al. (2016), the circulating nurse notices for openings in operating asepsis and synchronizes the requirements of the operating team. The duty of the circulating nurse is not cleaned in the situation but somewhat manages the care and situation during operation. On the other hand, in the viewpoint of Krupicet al. (2016), the instrument nurse work straight with the surgeon in the operation theatre. The instrument nurse organizes the disinfected equipment, anticipates the doctor's requirements, and passes apparatuses to the doctors who are involving in the surgical process and passes other items necessary during the process. Other duties of the instrument nurse consist of in the surgical site antiseptic draping, skin preparation, suctioning, retraction, irrigation etc.
As opined by Suarniet al. (2015), the RN first assistance is exceptionally experienced and provide prolonged pre-operative nursing care to the patient. Of crucial importance is that they must be qualified to give intravenous drug to the patient in case of an emergency. The main role of RNFA is not only to provide pre-operative care but also intro-operative and post-operative care. In the opinion ofModesittet al. (2016), the perianesthesia nurse is also called recovery nurse. The recovery nurse is responsible for intensive nursing care for the patient who get up form anesthesia. The main responsibility of this nurses is to observe the patient throughout the day and make it assure that the patient are not nauseous or at a loss.
Post-operative nursing care is delivered to the patient after surgery. The post-operative nursing care depends on the type of operation patient has and the condition of the patient after the operation. Post-operative care mainly include pain management and healing process that should be done just immediately after operation. As opined by Mangusanet al. (2015), thelevel of postoperative care needed depends on the person's pre-surgical health condition, nature of operation, and whether the operationwas performed in a day-surgery clinic or in the hospital.Patients who have processes done in a day-surgery clinicgenerallyneed only limited hours of care by health care specialists before the patientsare discharged. On the other hand, patient who are admitted in the nursing home and undergone critical operation then they require post-operative care for some days or weeks or may be months.
According to the evidence nursing method afteroperation, the patient is transferred to post anesthesia unit care and here the responsibility of the nurses is to monitor the patient 24 hours and note down their improvement or diminishment andinform to the doctor. For example, nurses monitor the blood pressureofpatient, total input and output of fluids, respiratory function of the patient, total blood count of the patient as blood loss is occur during the operation. Moreover, the nurses are responsible in order to dress the surgical site and take care of this weather there is any sign of over bleeding or not. Nurse measures not only the internal condition of the patient but also external condition of the patient after surgery. For example, pain status of the operation area, feeling of nausea or vomiting of the patient, consciousness of the patient etc. are also monitored by nurses. According to Titleret al. (2016), previously patient are transferring manually and the record keeping process was also done manually. It was seen that manual process was time consuming and there was chances of mistake in the manual process. In order to improve the facilities, hospitals are maintaining record keeping process technically.
Controlling pain is essential so that the patient may carry out deep breathing exercisesand may be able to turn in bed, sit down, andfinally walk. In the opinion of Mangusanet al. (2015), any critical sign and symptoms, respiratory status, drainage tube,chest excursion, lung sound etc. should be observed in every two to three hours of interval after operation. In addition, body temperature is measured by nurses as high fever is very common after surgery. If the patient does not need urinary catheter, the bladder should be measured for expansion, and the patient observed for incapability to urinate. On the other hand, after pain relief if the condition of the patientis improving then the patients are encouraged to sit up and walk.
The paper has been quite successful to point out the nature and common practices in terms of operative nursing care. In this context the paper evaluated the practices in light of evidence based research on individual subcategories of operative care. It has been identified that the preoperative care is dependent on the the condition of patient and the surgery as well.it has also been surfaced from the evaluation that patients who are prepared psychologically and physically for surgery have a tendency to have better surgical results. The evaluative study also disclosed that numerous amendments have been conducted in operative nursing care preface after the adoption of evidence based nursing model. In addition to that the paper uh has evidently established that the evidence based nursing practice is highly crucial for improvement of operative care plan.
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