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Preoperative Nursing Visit.pdf
- 1. Preoperative Nursing visit Nurse Halliru Kabir Kankara (Rn, Rpon) nursekankara@gmail.com Federal Teaching Hospital Katsina Introduction As the name implies, the preoperative visit by preoperative nurses is mandatory for a surgical patient prior to the day of surgery as a preparation process to prepare the patient well for the surgery, both physically, physiologically, and psychologically for the surgery. As well to enable the perioperative nurses to prepare for the surgery by making all necessary plans to ensure the success of the surgery without any complication through ensuring everything for the surgery is supplied and made available and ready for use for the surgery, including all the equipment, instrument, and consumables by ensuring their availability, functionality, and sterility. All for the purpose of making the patient's life better through having a successful surgery. A visit to a patient scheduled to undergo surgery can effectively mitigate preoperative anxiety in those patients, build up a positive attitude toward the upcoming surgery, instruct the patient to coordinate with the surgery, enhance surgical safety, and improve the degree of satisfaction regarding the nursing care in the operating room ( eye science, 2015). The preoperative assessment visit can no longer remain dominated by formal medical issues. Although medical assessment within the surgery is vital for safety purposes, the opportunity for a formal nursing visit and
- 2. assessment with regard to psychoeducational issues is gaining greater importance. This is especially the case when more ambitious surgical procedures are being undertaken on less fit patients ( Mark Mitchell, 2015). The patients need to be provided with the choice of information during preoperative visits and this choice is to be noted to advocate for them during the surgeries. Information provision is central to the psychoeducational plan and therefore the correct identification of the patient’s coping style during the preoperative visit is of paramount importance. Therefore, a preoperative visit from theatre staff especially the perioperative nurse who is a patient advocate has been deemed to be very important, such visits extend the window of opportunity(although very brief) in which the patient might benefit from interaction with the hospital personnel. (Gilmartin, 2014). Definitions of the preoperative visit Preoperative visit – This is a process of a visit that integrates and applies medicine, psychology, and sociology into the nursing care of perioperative patients prior to surgery, aimed at mitigating preoperative anxiety and preparing for intraoperative care, and accelerating postoperative recovery (Dan & wu, 2015). Preoperative visit/review- is referred to as one of the roles of a perioperative nurse meeting the patient one-on-one to interact, assess, educate, and form a rapport with the patient prior to surgery (Aliyu danjuma et el, 2015). From the above two definitions, the preoperative visit can literally be seen as the mandatory role of perioperative nurses which deals with a visit to a
- 3. surgical patient at least 12 hours to a day or two days prior to surgery. Aimed at assessing the patient's fitness, and level of preparedness, and educating/preparing the patient physically, physiologically, and psychologically, as well to enable the perioperative nurse to prepare for the care to be rendered to the patient intraoperatively the successful surgery. Objectives of the preoperative visit ● To educate and counsel the patient concerning the surgery and theatre expectations. ● To instruct the patient on the do’s and don’t of his/her surgery. ● To gather patient data through interviews. ● To guide perioperative nurses on intraoperative preparations of the surgery. ● To establish rapport with patients so as to alleviate their anxiety of the patient. ● To promote intraoperative cooperation by the patient. ● To assess the patient's fitness for the surgery. Principles of preoperative nursing visit ● Tailor to each individual patient. ● Two ways communication approach ● Should be done by an experienced perioperative nurse. ● The use of medical terms should be avoided. ● Listening skills are much needed. ● Should be done at least 12 hours to a day or a maximum of two days prior to surgery.
- 4. ● Correct and effective information should be passed. ● Information collection/interview should be through an official design preoperative visit form approved by the hospital. ● The perioperative nurses should appear in full theatre attire (in theatre outfit, mask, caps, google, etc) and explain to the patient that is the same way you will be met in the theatre. Pros of the preoperative visit ● It improves individualized intraoperative nursing care and efficiency. ● It prevents needless delays in the operating room. ● It fosters meaningful nurse-patient relationships. ● It helps the perioperative nurse review critical data before the procedure and assess the patient before planning for the case. ● It helps the perioperative nurse to plan ahead and prepare for expectations. ● Visit contributes to patient cooperation and involvement by facilitating communication. ● The visit makes intraoperative observations more meaningful by establishing a baseline for the measurement of patient outcomes. ● Visit enhance the positive self-image of the perioperative nurse and contributes to job satisfaction, which reduces job turnover and thus a benefit to the hospital. ● Serve as legal backing in case of ligation. Con's of the preoperative visit ● Cost containment measures may not provide adequate staffing to allow time to visit the patient.
- 5. ● It may be frustrating if patients are many or uncooperative. ● The admission of patients on the day of surgery, or late a day before the surgery, and the time eg schedule of emergency surgeries makes the timing of the visit difficult. ● If the nurses interviewing skills are not practically ok, the patients may feel their privacy is invaded or breached. ● Repetitious interviewing may lead to a stereotyped manner and lack of enthusiasm and spontaneity on the part of the nurse interviewers. ● Visits may produce or create friction among the different team factions if the program is not well planned and executed. ● If uncertain information or ambiguous statement is used, patient anxiety may be increased. The procedure of the Preoperative visit ● Obtain the patient list booked for the surgeries with details of wards, date of admission, diagnosis, plan of surgical procedure, and patient hospital number. ● Informed the ward nurses about/the purpose of your visit. ● The patient case folder should be collected to cross-check the names, ages, hospital numbers, diagnosis, and the proposed surgical procedure to ascertain the right patient and other details to know the level of preparedness of the patient. ● Formally introduced yourself to the patient, and explain the purpose so that to obtain the patient's consent. ( for child patients the parent are to be informed and consented ).
- 6. ● Assessment of the patient should be based on the nursing process approach with priority to pre, intra, and postoperative possible patient challenges. ● The approved/standard approach of the nursing interview should be used while interviewing the patient. ● Approved/standard pre-visit forms should be used while documenting the patient's interview responses. ● Give room for the patient to ask questions and respond appropriately with facts and correct information. ● Document all other findings related to patient fitness and preparedness and make recommendations based on your findings. ● Thanks to the patient and brief him on your findings. ● Critically analyzed the data to be used as a guide to intraoperative preparation. Barriers to a preoperative nursing visit ● Wrong timing of surgeries ● Lack of time by perioperative nurses. ● Inadequate knowledge of preoperative visits among perioperative nurses. ● Shortage of perioperative nurses. ● Hospital policy. ● Reluctance by the surgeons and anesthetist to allows the perioperative nurses to conduct visits to surgical patients. ● Lack of interest by perioperative nurses.
- 7. ● The inability of some perioperative nurses to understand fully some of the patients' cultural, ethnic, and value system differences. ● The inability of some perioperative nurses to understand and recognize how personal beliefs and biases can influence objectivity. ● Language barrier. ● Lack of proper orientation on preoperative visits during perioperative nursing training. ● Tight schedules and the nature of the perioperative nursing practice. Standard preoperative visit form PRE-VISIT FORM Personal Data Name:--------------------------------------- Age:-------------------------------- State of Origin:---------------------------- L.G.A:----------------------------- Language Spoken:----------------------- Home Address:----------------- Phone (if any):---------------------------- Office Address:------------------ Religion;------------------------------------ Nationality:----------------------- Occupation:-------------------------------- Phone number;----------------- Name of Next of Kin:-------------------- Relationship:-------------------- Address of Next of Kin:--------------------------------------------------------- Phone Number of next kin:---------------------------------------------------
- 8. Consultant:------------------------------- Date of Admission:-------------- Immunization ECG:-------------------- Whooping cough:---------------- Medical Diagnosis:--------------------- Allergies:-------------------------- Poliomyelitis;----------------------------- Tetany:----------------------------- Diptheria:--------------------------------- Measles:--------------------------- Others:------------------------------------ LMP:-------------------------------- EDD;----------------------------------------- NURSING HISTORY State Of Health:--------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ --------------------------------------------------------------------- Informant:----------------------------------------------------------------------- Place:--------------------------------------------------------------------------- Present:-------------------------------------------------------------------------------- ------------------------------------------ Nutrition:------------------------------------------------------------------------Elim ination:--------------------------------------------------------------------------------- ------------------------------------------------------------------------ Activity/Exercise:-------------------------------------------------------------------- ------------------------------------------------------------------------------
- 9. Sleep and Rest:------------------------------------------------------------------------------------ --------------------------------------------------------------------- Communication /Special Senses:--------------------------------------------------------------------------------- ------------------------------------------------- Feeling about self/image:----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ ------------------------------------------------------------- Family/Social Relationship:-------------------------------------------------------------------------- ---------------------------------------------------------------- Sexuality/Reproduction:------------------------------------------------------------ ---------------------------------------------------------------------------- Coping with stress:---------------------------------------------------------------------------------- ------------------------------------------------------------------- Values and Beliefs:--------------------------------------------------------------------------------- -------------------------------------------------------------------- Other information (i.e Habits):-------------------------------------------------------------------------------- ------------------------------------------------------- Knowledge of Anaesthesia:--------------------------------------------------------------------------- ---------------------------------------------------------------
- 10. Previous knowledge of Surgical Procedure:----------------------------------------------------------------------------- ---------------------------------------- Present Knowledge of illness:--------------------------------------------------------------------------------- ------------------------------------------------------ Fear of the unknown- Write the Patient's Fears in his/her own words:---------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ -- Consent Form:----------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ ----------------------------------------------------------- Financial Capabilities (Sponsors):---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ --------------------------------------------------- Site of Operation- showed: {-----------} Not shown: {----------} Skin Preparation- Done: {----------} Not done: {-----------} Family History: (Hypertension, Tuberculosis, Leprosy, Convulsion, Peptic Ulcer, Psychiatry, Diabetes, Allergies,
- 11. etc.):------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ ----------- PHYSICAL EXAMINATION MEASUREMENT Pulse:------------------------------ Respiration:------------------------------ Temp:------------------------------ BP:--------------------------------- Height:------------------------------- Urinalysis:----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ -------------------------------------- Apex beat:--------------------------------- Weight:---------------------------- General Inspection - Head to toe:------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------
- 14. NURSING CARE PLAN Date and time s/no Nursing Diagnosis Nursing objective Nursing action/order Scientific rationale Nursing evaluation Signature and date
- 15. PREOPERATIVE NURSING INTERVIEW FORMAT Date------------------- Patient’s name----------------------------------Interviewer------------------------------------ Hospital number------------------------------Ward------------------Bed number----------------Surgeon--------------------anaesthetist------------------- Time started---------------Time ended----------- Areas of assessment Action taken by perioperative nurse 1. History: Allergies eg chloroquine Dentures: Prosthesis- eg artificial leg or eyeball. Previous surgery- eg caesarean section. Major accident- eg R.T.A Physical problems: 2. Communication ; Language- eg igbo, yaroba, or Hausa.
- 16. Audio – eg very poor hearing. Comprehension- rg good if not too technical. 3. Social status; Spouse; eg married, single, Mrs. Children; eg eight Problems; eg single parent, petty trader (a widow) 4. Others Emotional status; eg expresses some fears Spiritual status; eg jehoba no blood transfusion. Special procedures; eg bladder drainage. Drains/catheters. Instructions preoperatively; eg
- 17. explain the sequence of events. Explains/demonstrate. And have the patient give a return demonstration of post-operative exercises; i.e deep breathing, turning, leg and foot exercises(etc). The proper method of getting out of bed. The essence of taking prescribed drugs. NURSING PROBLEM NURSING DIAGNOSIS A) A) B) B) C) C) D) D) E) E) Patients are VIPs . REFERENCES
- 18. ⮚ Ablan, R. (2016) „Barriers to Preoperative Teaching in a Culturally Diverse Healthcare ⮚ Aliyu Danjuma ., Ibrahim T. A., Sunday O. O., Silas K., Oluwafemi M. O., and Patience E., (2015). Knowledge, attitude and practice of preoperative visit: A survey of Nigerian perioperative nurses: American Journal of Health Research; 3(1-1): 54-60. doi: ACI,(2014) ⮚ Operating Theatre Efficiency Guidelines: A guide to the efficient management of operating theatres in New South Wales hospitals. ⮚ Ali,., Lalani, N.S. and Malik, A., (2015). Pre-operative assessment and education. Surgical Science, 3(01), p.10. 10.11648/j.ajhr.s.2015030101.18ISSN: 2330-8796 ⮚ Ann Malley, Kenner, C., Kim, T. and Blakeney, B.,(2015).The role of the nurse and the preoperative assessment in patient transitions. AORN Journal, 102(2), pp.181-e1. HHS Public Access, 102(2), pp. 1–13. doi:10.1016/j.aorn.2015.06.004. ⮚ Dictionary, M.W., (2010). Merriam-Webster online dictionary. Retrieved November 6, 2021. ⮚ Gerlitz, R., (2017).Barriers and facilitators of preoperative education within Enhanced Recovery After Surgery (ERAS) programs. ⮚ Gilmartin, J., and Wright, K.,(2008) „Day surgery: Patients‟ felt abandoned during the preoperative wait‟, Journal of Clinical Nursing, 17(18), pp.2418–2425. doi:10.1111/j.1365-2702.2008.02374.x. ⮚ Grossweiler, H., (2012)."Preoperative Education: How Effective Teaching Impacts Knowledge with the Surgical Patient" Nursing Theses and Capstone Projects, Paper 119.Retrieved from:https://digitalcommons.gardnerwebb.edu/cgi/viewcontent.cgi?article=1119&con text=nursing ⮚ B. and Zoëga, S.,(2017) „Role of patient education in postoperative pain management‟, Nursing Standard, 32(2), pp. 50–63. doi:10.7748/ns.2017.e10939.