Day Surgery Workbook Student Name Cohort Module Placement date
Contents of the workbook AIMS OF THE WORKBOOK...3 PRINCIPLES OF DAY SURGERY...4 THE ROLE OF THE NURSE IN DAY SURGERY...5 PRE ASSESSMENT FOR DAY SURGERY...7 ADMISSIONS...8 THE PRE OP CHECK LIST-...9 THEATRE...11 RECOVERY...14 STEP DOWN AND DISCHARGE...17 LEGISLATION...18 REFLECTION...19 REFERENCES...21 NOTES...22 Christine Ely Page 2 17/12/2002
Aims of the workbook This workbook should be included, as part of your evidence of learning for your Practice Based Assessment and on return to you after marking this should be placed in your Portfolio document. You do not have to complete the workbook sequentially and may start at any section that links to your experiences in day surgery. You should write in this book and this sign indicates an activity for you to complete The workbook covers the areas that you will be allocated to throughout your experience in day surgery and provides you with some structured questions for you to answer and other information. It concludes with a reflection exercise, which should help identify your learning from this placement. The staff in day surgery can help you to find the answers to the workbook questions. You should also discuss your progress, with this workbook, with your mentor who can direct you to the other learning resources that can be a source of information. Christine Ely Page 3 17/12/2002
Principles of Day surgery With improvements in anaesthesia and techniques, such as minimal invasive or keyhole surgery, in the last few years, there is now more scope for treating surgical patients as day cases (Markanday, 1997). The advantage of a specially designated area for day cases, as here at St Bart s, is that the particular needs of day cases can be more readily met. Day surgery may also be known as Ambulatory Care or Ambulatory Surgery. Identify 3 advantages of day surgery for the patient 1. 2. 3. What further advantages are there for the organisation? What are the possible disadvantages of day surgery? Christine Ely Page 4 17/12/2002
The role of the Nurse in Day Surgery The model of nursing developed by the theorist Hildergard Peplau identifies that nurses at different times assume specific roles to meet a patient s needs. These professional roles require the use of interpersonal skills to achieve positive changes that enhance the patient s recovery (Simpson, 1991). The roles in Peplau s model are identified in the table below. From your observations in the various areas in day surgery give one example of each these roles demonstrating a sensitive/appropriate approach to patients or staff needs. Peplau Role Stranger -one who meets the patient as stranger. Your experience or observation of how the nurse managed this role positively. Teacher one who imparts knowledge concerning a need or interest Resource One who provides specific, needed information that aids in understanding of a problem or a new situation. Counsellor One who, through the use of certain skills and attitudes aids another in recognising, facing, accepting, and resolving problems that are interfering with the other person s ability to live happily and effectively. Christine Ely Page 5 17/12/2002
Leader One who carries out the process of initiating and maintaining of group goals through interaction Technical expert One who provides physical care by displaying clinical skills and operating equipment in this care (Belcher and Fish 1995) Surrogate One who takes the place of another. Christine Ely Page 6 17/12/2002
Pre Assessment for Day Surgery Patients must meet specific criteria to ensure that they are suitable for day surgery. Fysh (2000) cites the guidelines of the Audit Commission (1992) who state that all patients should first be considered for Day Surgery and only those who do not meet the selection criteria because of certain social or medical factors are referred for inpatient treatment. Sutherland (1996) notes that as well as high quality peri-operative (the period immediately before and after an operation) care nurses in Day surgery units need to appreciate the high levels of psychological support and information needs of their patients. Identify three factors, which would make a patient unsuitable for day surgery. - 1 2 3 What tests might need to be completed prior to day surgery and why? Christine Ely Page 7 17/12/2002
Admissions It is essential that you always welcome your patient with a friendly smile and greet them by name in a manner that will allay anxiety (Edmondson, 1996). The experience of stress, as noted by Welsh (2000), is a complex response to anxiety. High levels of stress can be detrimental to a patient s recovery. Patients do find the process of waiting and the time between arrival and the procedure an area of concern (James, 2000). Patients may have a great number of psychological fears about anaesthesia such as not waking up, or talking inappropriately. Nurses in day surgery should aim to reduce stress helping the patient with positive coping mechanisms. Briefly describe ways of reducing the stress in the pre- operative period in day surgery. Christine Ely Page 8 17/12/2002
THE PRE OP CHECK LIST- You will during the programme prepare patients for surgery. It is important that you understand the rationale for the actions that you need to check have been completed to ensure the patient s safety. Provide the rationale to explain why these actions are necessary prior to surgery. Check list items Patient has two ID bands with correct information Rationale for this. Consent form is signed Premed given and time on chart Dentures are removed and any bridgework noted. Hair clips jewellery removed and wedding ring taped over. Make up and nail varnish removed Prosthesis removed including hearing aids, contact lenses. Christine Ely Page 9 17/12/2002
Baseline observations are recorded Height and weight recorded if general anaesthetic is to be given Patient has passed urine and had a urine test in pre admission Time Nil by mouth started Notes and X rays are with the patient Operation site is marked if necessary Haemaglobin is noted Sickle cell test Consent for pr medication documented Christine Ely Page 10 17/12/2002
Theatre Define the term anaesthesia What is the difference between a general and local anaesthetic? What precautions are necessary prior to moving and handling an unconscious patient? Operating theatres are controlled and enclosed environments that aim to exclude micro-organisms to minimise infection. What special controls are used to reduce the problems of infection? Christine Ely Page 11 17/12/2002
How does the practice of hand scrubbing in the operating theatre differ from the hand-washing procedure that you normally use in the ward environment? Sterility List the methods for sterilising instruments. Explain how instrument packs are opened and the items laid out on the trolley ready for use in theatres? Christine Ely Page 12 17/12/2002
Types of surgery observed List below, in the first column the operations that you have seen performed in Day Surgery. Then complete the following table by explaining briefly in column 2 what the operation entailed. Operation Your explanation of the procedure Christine Ely Page 13 17/12/2002
Recovery What are the principles of observation in the recovery area? Pain, nausea and vomiting are commonly the most significant complaints from patients after day surgery(jakobsson,2000). Explain the term analgesia. Explain the term anti-emetic Christine Ely Page 14 17/12/2002
Use the following table to keep a record of the drugs that you have observed being given for analgesia in the recovery area. Pharmaceutical name Proprietary name Mode of action Route of administration Usual dosage Side effects and complications Christine Ely Page 15 17/12/2002
Step Down and Discharge Patients in the step down area may feel that they are under pressure to go home (Cahill and Jackson, 1997) however, they should be carefully monitored to ensure that they are not rushing to go before they are ready. In the St Bart s unit reclining chairs are used and the advantage of this is that it allows interaction between relatives and is a more relaxed area than if there were hospital beds. However, patients in step down still need to be carefully observed for any problems. Discharge should have been pre planned prior to admission but patients will need to be given specific information. In the step down area patients are given information and advice on their further recovery. Health education is defined as What sort of verbal information is given prior to discharge? What sort of written information is given prior to discharge? Why might a patient need to be transferred to a ward instead of discharge home? Christine Ely Page 17 17/12/2002
Legislation This exercise links to the PBA outcome for module 2 related to legislation. Explain the meaning of the term legislation in one to two sentences? In the following list, tick any, which are items of legislation? 1. Manual Handling Operations Regulations 1992 [ ] 2. The Patients Charter 1991 [ ] 3. Health and Safety at Work Act 1974 [ ] 4. Nursing and Midwifery Council Code of Conduct 2002 [ ] 5. Display Screen Regulations 1992 [ ] 6. Control of Substances Harmful to Health Regulations 1994 [ ] 7. Infection Control Policy [ ] 8. Access to Medical Records Act 1990 [ ] 9. Data Protection Act 1984 [ ] 10. Misuse of Drugs Regulations 1985 [ ] Christine Ely Page 18 17/12/2002
Reflection There are many different views of what reflection is (Ghaye and Lillyman, 2000) but in this instance the following definition from Boud, Keogh and Walker (1985) might be useful to give direction to your review of your placement in Day Surgery. Accordingly reflection can be considered A generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new understandings and appreciations. (Boud et al, 1985:19) Reflection is about recognising the learning that you have had from experience and identifying how you will use this to improve your practice in the future. As learning can be considered as the acquisition of knowledge, skills and attitudes (Jarvis, 1995) and this can be used as a structure for your personal reflections. Knowledge What have you learnt? How will you use this learning in the future? Christine Ely Page 19 17/12/2002
Skills What have you learnt? How will you use this learning in the future? Attitudes What have you learnt? How will you use this learning in the future? Christine Ely Page 20 17/12/2002
References Belcher, J. R. and Fish, L. J. B. (1995) Hildegard E. Peplau. In: George, J.B. Nursing Theories The Base for Professional Nursing Practice. 4 th ed. London: Prentice Hall International Boud, D., Keogh, R. and Walker, D. (1985) Promoting Reflection in: Learning: A model. In: Boud, D., Keogh, R. and Walker, D. eds. Reflection: Turning Experience into Learning. London: Kogan Page. Cahill, H. and Jackson, I. (1997) Day Surgery Principles and Nursing Practice. London: Bailliere Tindall. Edmondson, M. (1996) Pre-assessment for Day Care. In Penn, S., Davenport, H.T., Carrington, S. and Edmondson, M. Principles of Day Surgery Nursing. Oxford: Blackwell Science. Fysh, R. (2000) Patient selection. In: Hodge, D. Day Surgery A Nursing Approach. Edinburgh: Churchill Livingstone. Ghaye, T. and Lillyman, S. (2000) Reflection: Principles and practice for healthcare professionals Wiltshire: Quay Books Mark Allen Pub.Ltd. Jakobsson, J. (2000) Postoperative pain and emesis; a systematic approach. In: Smith, I. (ed) Day Care Anaesthesia. London: BMJ Books. James, D. (2000) Patient perceptions of day surgery. British Journal of Perioperative Nursing 10(9) 466-472. Jarvis, P. (1995) Adult and Continuing Education: Theory and Practice 2 nd ed. London: Routledge Markanday, L. (1997) A brief history and the development of day surgery, In: Markenday, L. (ed) Day Surgery for Nurses London: Whurr Publishers Ltd. Simpson, H. (1991) Peplau s model in action Basingstoke: Macmillian. Sutherland, E. (1996) Day Surgery A Handbook for Nurses London: BailliereTindall. Welsh, J. (2000) Reducing patient stress in theatre. British Journal of Perioperative Nursing 10(6) 321-327. Christine Ely Page 21 17/12/2002
Notes Christine Ely Page 22 17/12/2002