Developments in Surgical

nursing: A Global perspective

Professor Joy Notter

Birmingham City University

History of surgical nursing

• Difference in surgical and

medical nursing

recognised from late 19th

/ early 20th century as

nursing role became

established and surgical

possibilities increased

• At same time in USA

parallel role -anaesthetic

nurses spread to other

countries – still separate

Non-ward Surgical nurses

• This role of surgical

nursing was in

operating room

• Mainly cleaning and

preparing the room

• Practical training not

formal courses

• But acceptance of

ability to prepare

instruments

Florence Nightingale

• Formalised nurse education

and training

• Start of development of

national programmes

• Previously no consistency

• Two kinds of surgical

nursing

– Surgical nursing mainly in

operating theatre

– Nursing patients on surgical

wards taught as separate

aspect of training

Surgical nursing

• 1930s nurses taught general programme which

include medicine and surgery. Although wards

increasingly separated into medicine and surgery

• 1960s start of specialisation extending role of

nurses in surgery

• 1970s courses for specialist nurses

• 1980s move towards advanced practice and

higher degrees

• 1990s masters level advanced practice and

nurse consultant roles

Today in USA: Circulating Nurse

• S/he is in charge of the operating theatre

• Manages the care of a patient during surgery;

• Ensures the sterile integrity of the operating

room, equipment, and materials;

• Enters data that records the procedures;

• Assesses the patient’s condition

– before, during, and immediately following surgery.

Education for circulating nurse

• Initial nursing degree

• Post-qualifying

period in practice

• Specialist surgical

nursing training or

degree

• Operating room

training certificate

Recently Change in title in some

countries to reflect role

Surgical nursing Perioperative nursing

What is meant by

perioperative nursing?

Perioperative nursing is a term

used to describe nursing through the

entire span of surgery, including what

occurs before, during, and after the

actual operation.

Phases of perioperative nursing

Preoperative: begins with the decision to perform

surgery and continues until the client has reached the

operating area.

Intraoperative: includes the entire

duration of the surgical procedure, until

transfer of the client to the recovery area.

Postoperative: begins with admission to the recovery area and

continues until the client receives a follow up evaluation at home, or is

discharged to a rehabilitation unit.

:

Preoperative

III. Review preoperative laboratory

and diagnostic studies

II. Review the client’s health history

and preparation for surgery

I. Assess physical needs

IV. Assess psychological needs

V. Assess cultural needs

• Ability to communicate

• Vital signs

• Level of consciousness

• Confusion

• Drowsiness

• Unresponsiveness

• Weight and height

• Skin integrity

• Ability to move/ ambulate

• Level of exercise

• Prostheses

• Circulatory status

I Assess physical condition:

• History of present illness and reason for surgery

• Past medical history

• Medical conditions (acute and chronic)

• Previous hospitalization and surgeries

• History of any past problem with anesthesia

• Allergies

• Present medications

• Substance use: alcohol, tobacco, street drugs

• Review of system

I. Check documentation of the client’s

health history and preparation for surgery:

• Complete blood count.

• Blood type and cross match.

• Serum electrolytes.

• Urinalysis.

• Chest X-rays.

• Electrocardiogram.

• Other tests related to procedure or client’s medical

condition, such as: prothrombin time, partial

thromboplastin time, blood urea nitrogen, creatinine, and other radiographic studies.

II. Check preoperative laboratory and

diagnostic studies

• Emotional state

• Level of understanding of surgical procedure, preoperative and

postoperative instruction

• Coping strategies

• Support system

• Roles and responsibilities

IV. Assess psychological needs:

• Language-need for interpreter

• Specific family/ cultural patterns

• Gender issues in care

• Specific dietary needs

• Special religious needs

V. Assess cultural needs:

Intraoperative

II. Intraoperative nursing

I Type of surgery

• Diagnostic → Removal and study of tissue to make a

diagnosis

• Exploratory → Most extensive means to involve exploration

of a body cavity or use of scopes inserted though small

incision.

• Curative → Removal or replacement of defective tissue to

restore function.

• Palliative→ Relief of symptoms or enhancement of function

without cure.

• Cosmetic→ Correction of defects, improvement of

appearance, or change to a physical feature.

Type of surgery

Intraoperative nursing

• Prepare/ check operating room

• Prepare sterile packs

• Set and check instruments

• Assist surgeon or anaesthetist

• Check biopsies and forms

• Check /weigh removed tissues

• Check instruments and swabs

• Check documentation

• Transfer patient to recovery

• Reset operating room

Nurse’s Main Responsibilities

in Postoperative Phase

• Ensure a patent airway

• Help maintain adequate circulation

• Prevent or assist with the treatment of

shock

• Maintain proper position and function of

drain tubes and IV infusion

• Monitor for potential complications

Postoperative

I. Immediate postoperative period

II. Later postoperative period

III. Preparation for transfer or

discharge

Immediate postoperative

period.

• Airway patency

• Effectiveness of respiration

• Presence of artificial airways

• Mechanical ventilation, or supplemental oxygen

• Circulatory status, vital signs

• Wound condition, including dressings and drains

• Fluid balance, including IV fluids, output from catheters

and drains and ability to void

• Level of consciousness and pain

Later postoperative period

• Respiratory function

• General condition

• Vital signs

• Cardiovascular function

• Fluid status

• Pain level

• Bowel and urinary elimination

• Dressings, tubes, drains, and IV lines

Preparation for transfer or

discharge • Monitor healing

• Monitor mobility

• Assess condition

• Meet with family

• Check home situation

• Check information for community care

• Check medication etc to take with them

• Check transport processes for transfer/

discharge

Future for perioperative nursing

• It will be faster paced and more complex.

• It will be much more linked to technology

• Team work and communication will be critical.

• The culture of the Operating Room will change

to give nurses a lead role

• Perioperative nurses will

monitor and lead on patient

safety and risk

management issues.

The future

• Increased recognition of expertise

• Increased ability to do minor surgery

• Today in some countries advanced

practitioners can take additional training and:

– Can make own admission checks

– Can order all necessary tests including blood tests

– UK prostate biopsies – one practitioner 2- 400 per

year

– Australia – vasectomies, athroscopies

in Future: Different knowledge

and skills needed • In addition to current knowledge and

competencies other information and skills

will be needed including:

– An understanding of informatics & software

management

– physics

– Radiology

– nanotechnology

– technology management

New trends – Dr Hamlin

in Sydney identified

• Perioperative Nurse Practitioner (in

Australia and Canada)

• Surgical Care Practitioner(SCP) and

Perioperative Specialist Practitioner (PSP)

in UK.

• Perioperative Nurse Surgeon’s Assistant

(PNSA) in rural Australia. It is similar to:

• Registered Nurse First Assistant (RNFA)

in Canada and USA

Advanced roles

• Nurse Anesthetist (in USA)

• Nurse sedationist (in Australia)

• Nurse endoscopist (in UK and

just beginning in Australia)

• Surgical nurse liaison roles

Other evolving roles

• Outside the operating

room setting. The day

surgery role is now very

well defined.

• advanced roles in pre-

anaesthetic and pre-

surgical clinics assessing,

screening and including

patient and family

education

Thank you