The document discusses the history and evolution of surgical nursing from the late 19th century to present day. It covers the development of specialized surgical nursing roles including circulating nurses, perioperative nurses, and advanced practice roles. The future of surgical nursing is discussed, highlighting trends toward increased specialization, advanced practice roles, and the need for skills in areas like informatics, technology management, and radiology to support more complex surgical procedures.

1. Developments in Surgical
nursing: A Global perspective
Professor Joy Notter
Birmingham City University

3. 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

4. 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

5. 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

6. 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

7. 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.

8. Education for circulating nurse
• Initial nursing degree
• Post-qualifying
period in practice
• Specialist surgical
nursing training or
degree
• Operating room
training certificate

9. Recently Change in title in some
countries to reflect role
Surgical nursing Perioperative nursing

10. 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.

11. 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.

12. :
Preoperative
I. Assess physical needs
II. Review the client’s health history
and preparation for surgery
III. Review preoperative laboratory
and diagnostic studies
IV. Assess psychological needs
V. Assess cultural needs

13. I Assess physical condition:
• 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

14. I. Check documentation of the client’s
health history and preparation for surgery:
• 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

15. II. Check preoperative laboratory and
diagnostic studies
• 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.

16. IV. Assess psychological needs:
• Emotional state
• Level of understanding of surgical procedure, preoperative and
postoperative instruction
• Coping strategies
• Support system
• Roles and responsibilities

17. V. Assess cultural needs:
• Language-need for interpreter
• Specific family/ cultural patterns
• Gender issues in care
• Specific dietary needs
• Special religious needs

18. Intraoperative
I Type of surgery
II. Intraoperative nursing

19. 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.

20. 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

21. 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

22. Postoperative
I. Immediate postoperative period
II. Later postoperative period
III. Preparation for transfer or
discharge

23. 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

24. 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

25. 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

26. 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.

27. 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

28. 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

29. 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

30. Advanced roles
• Nurse Anesthetist (in USA)
• Nurse sedationist (in Australia)
• Nurse endoscopist (in UK and
just beginning in Australia)
• Surgical nurse liaison roles

31. 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

32. Thank you