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Introduction to Perioperative Nursing Practice : NUR 201-001, Intersession 2021-2022
In this course, I was introduced to core concepts of perioperative nursing: the role, standards of practice and the principles of quality and safety. I have experienced practical and hands-on demonstrations of specialized skills coupled with an observational experience in the operating room.
Darah Daskalakis
NUR 201-001
Professor T. Criscitelli
4 January 2022
Narrative Reflective Log
What I learned today that stood out the most was the fact that maintaining safety and specific responsibilities for both the team and surgical patient in the operating room is crucial for optimizing patient outcomes. This can be done through utilizing safe nursing practices, knowing the roles and responsibilities of the team members, team STEPPS, effective communication, and knowing about the accountability and scope of practice in the operating room. This information will be very valuable to my nursing practice because it is all information that not only operating room nurses must know, but all nurses in general. The safety of team members and the patients should always be the number one priority, no matter which field of nursing. Knowing how to handle situations (both individually and working as a team), your specific role, and looking for the best outcome of the patient will always be valuable in nursing. The information learned today impacts my clinical experience by opening my eyes to operating room nurses, specifically, which is something I previously haven’t learned about in nursing school. The tactics and strategies that can be applied to strengthen what I have learned would be to follow the protocol of peri-operative environments, in order to encourage safe patient care practices, promote optimal patient outcomes, and to foster a durable workplace. A way I can do this would be to dress accordingly in the OR (not wearing lots of jewelry, wearing a scrub suit/head covering, mask, using a disposable stethoscope, etc.). Doing so will decrease the likeliness of causing infections, thus, promoting a better outcome for the patient and health care providers. What I learned that was different from what I previously thought before beginning this course was regarding the cultural/religious aspect of patient care. I was not aware that many surgical products contain bovine and porcine, so now I am more aware of the fact that pre-op interviews regarding the patient’s religious beliefs and personal preferences need to be thoroughly accounted for. I am still curious about the hours, on average, in which a peri-operative nurse works and how their day is run in order to avoid burnout.
Darah Daskalakis
NUR 201-001
Dr. Criscitelli
January 4, 2022
Roles In The Operating Room Assignment
Discuss who you saw in the video and what were they doing?
-In this video, I observed a scrub nurse/certified surgical technologist or circulator keeping track and counting all of the necessary items before the patient arrives in the operating room. In order to do this, the two team members counted the instrumentation used for the case (disposable and non-disposable). I also observed two other team members starting the process called “turnover”, where the operating room is cleaned between each case. During a turnover, trash is collected, equipment is wiped down and the environment is cleaned using chemicals, getting the room ready for the next case.
What else did you notice?
-In the video, I was also shown the “sterile core area,” where all of the case carts and instruments are staged for the cases to come throughout the day. Once a turnover is complete, these case carts and instruments are brought to the operating room to start the opening sequence.
What questions do you have?
-Some questions I would have after watching this video would be “what happens if the instruments are miscounted and nobody catches onto the error?” along with “How long does it typically take to prepare an operating room?”
Darah Daskalakis
NUR 201-001
Dr. Criscitelli
January 6, 2022
Surgical Fires Assignment
Discuss what are the items in the operating room that can ignite a fire?
Fires occur when an ignition source, a fuel, and oxygen come together. Each member of the surgical team should be aware of these 3 elements and their related fire risks. Some examples include surgeons typically using ignition sources, such as electrosurgical pencils. Operating room nurses help apply prep solutions and other potential fuels. Anesthesia professionals control the delivery of oxygen and nitrous oxide. Because of these things, the entire surgical team should discuss the risk of fire for every patient, using a pre-op timeout to do so in order to identify fire risks and coordinate preventative methods.
What can you do as a member of the surgical team to prevent a fire?
As a team member of the surgical team, in order to prevent a fire, I would do a number of things. Some things I would do would include eliminating open delivery of supplemental oxygen during sedation, securing the airway if the patient requires an increased oxygen concentration, and allowing time for alcohol based preps to dry before draping the patient. Restricting the delivered oxygen concentration to 30% or less will minimize fire risks during exceptional surgeries and may provide an acceptable oxyhemoglobin saturation- but room air is preferred whenever possible. I would always start with the lowest oxygen concentration required to keep the patient safe. Along with these measures, it would be helpful to blend air and oxygen, dilute the under-drape space with air, use alternative surgical modalities, and use modified draping techniques.
What should you do if a fire occurs?
If a fire occurs, you should work as a team in order to rectify the situation and minimize injury. The anesthesia professional should remove any source of oxygen from the fire. The surgeon and scrub nurse can pull off the burning drapes while another staff member pours saline on and around the patient to douse the fire. The circulator can use a fire extinguisher to put out the burning drapes (if needed) once they are removed from the patient.
Darah Daskalakis
NUR 201-001
Prof T. Criscitelli
11 January 2022
Narrative Reflective Log #2
What I learned today that stood out involved opening a sterile field, gowning and gloving, transferring medications to the sterile field, and opening trays. All of this information will be valuable in my nursing practice because maintaining sterility and aseptic techniques will keep infection rates low in the patients who are having procedures done, as well as it keeps the work for the healthcare providers organized throughout the procedures. The information that I learned today will impact my clinical experience by the means of properly teaching me how to preform activities involved in peri-operative nursing (donning/doffing sterile techniques for PPE, how to open/transfer medications onto a sterile field to prepare for a surgical procedure, opening trays). Watching these videos better prepares me for the “real world,” giving me a heads up of what to expect to do in a clinical setting. I feel that the tactics/strategies that can be applied to strengthen what I have learned will be to practice these techniques hands on. Taking part in this week’s module makes me feel a little more prepared, giving me a base of what to know before getting to practice these techniques in person. In the beginning of this course, I did not have a broad knowledge regarding how to check the sterility of the items/instruments involved in surgical procedures. I found it very fascinating to see the different devices used that can indicate the sterility of the tools used for a procedure. Thank you!
Pre-Op Assessment Assignment
~~ The pre-operative assessment is an opportunity to identify co-morbidities that may lead to patient complications during the anesthetic, surgical, or post-operative period. Patients scheduled for elective procedures will generally attend a pre-operative assessment 2-4 weeks before the date of their surgery. Some important questions to ask the patient would include:
-“Would you please tell me your name and date of birth?” (to verify the patient’s name and birthday).
- “Are you allergic to anything? Do you have any sensitivities to latex or betadine?” (To confirm the patient’s allergies and ask about sensitivities to latex or betadine).
- “When was the last time you had anything to eat or drink?” (To verify the patient’s NPO status).
- “Do you have any jewelry on, or any piercings in any place that I can’t see right now?” (To ask about body piercings and jewelry).
-“Do you know who will be doing your surgery?” (To verify the patient’s surgeon).
- “Do you have any metal inside your body – any plates, pins, or screws?” (To ask about any metal inside the patient’s body).
-“Has your surgeon marked the place where we’ll be operating?” (To verify that the surgical site has been marked – if necessary).
-“Do you have any dentures, partials, or hearing aids on?” (To ask about dentures , partials, or hearing aids).
-“Do you have any other questions or concerns?” (To make sure the patient is comfortable and confident in the procedure they will undergo/to ease any anxiety).
~~In order to reduce a patient’s anxiety prior to an operation, I would allow the patient to ask open questions so that I may answer them to alleviate any uncertainty or stress that they may have, due to the fact that they are not 100% sure of what will actually be going on during their procedure. If it were a child, I would ease their anxiety by trying to distract them as much as possible to keep their mind off of the upcoming procedure. I would give them things like coloring books, toys, let them play a video game, or watch a movie beforehand in order to make the patient as comfortable as possible.
Universal Protocol Assignment
Universal Protocol Assignment
Conduct a pre-procedure verification process:
Address missing information or discrepancies before starting the procedure.
Verify the correct procedure, for the correct patient, at the correct site.
When possible, involve the patient in the verification process.
Identify the items that must be available for the procedure.
Use standardized list to verify the availability of items for the procedure, including relevant documentation (Examples: history and physical, signed consent form, pre-anesthesia assessment), labeled diagnostic and radiology test results that are properly displayed (Examples: radiology images and scans, pathology reports, biopsy reports), any required blood products, implants, devices, special equipment.
Mark the procedure site:
At a minimum, mark the site when there is more than one possible location for the procedure and when performing the procedure in a different location could harm the patient.
For spinal procedures: Mark the general spinal region on the skin. Special intra-operative imaging techniques may be used to locate and mark the exact vertebral level.
Mark the site before the procedure is performed. If possible, involve the patient in the site marking process. The site is marked by a licensed independent practitioner who is ultimately accountable for the procedure and will be present when the procedure is performed.
In limited circumstances, site marking may be delegated to some medical residents, physician assistants (P.A.), or advanced practice registered nurses (A.P.R.N.).
Ultimately, the licensed independent practitioner is accountable for the procedure – even when delegating site marking.
The mark is unambiguous and is used consistently throughout the organization. The mark is made at or near the procedure site. The mark is sufficiently permanent to be visible after skin preparation and draping.
Adhesive markers are not the sole means of marking the site.
For patients who refuse site marking or when it is technically or anatomically impossible or impractical to mark the site, use your organization’s written, alternative process to ensure that the correct site is operated on. Examples of situations that involve alternative processes can be those involving: mucosal surfaces or perineum, minimal access procedures treating a lateralized internal organ, whether percutaneous or through a natural orifice, teeth, premature infants, for whom the mark may cause a permanent tattoo.
Preform a time out:
The procedure is not started until all questions or concerns are resolved. Conduct a time-out immediately before starting the invasive procedure or making the incision. A designated member of the team starts the time-out.
The time-out is standardized. The time-out involves the immediate members of the procedure team: the individual performing the procedure, anesthesia providers, circulating nurse, operating room technician, and other active participants who will be participating in the procedure from the beginning.
All relevant members of the procedure team actively communicate during the time-out. During the time-out, the team members agree, at a minimum, on the following: correct patient identity, correct site, procedure to be done.
When the same patient has two or more procedures: If the person performing the procedure changes, another time-out needs to be performed before starting each procedure.
Document the completion of the time-out. The organization determines the amount and type of documentation.
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