Journal Reading

KRISTIAN KARL B. KIW-IS

BSN IV-A

December 6-8, 2021

What is the perioperative nurses main challenge when caring for the
surgical patient?
Brid O’ Brien School of Nursing & Midwifery, UCC

Introduction
This study looked to speak and listen to nurses working in the perioperative setting to identify and
resolve their main challenges and concerns. Perioperative nursing is defined as the care of the patient
before, during and immediately after surgery and has a rich history. Being at the frontline of care, the
challenges and concerns nurses continually face in their daily working lives impact on the care they
deliver to the patients in their care The nurses who participated in the study were all qualified and
ranged from working in the perioperative setting from six months to thirty three years and were in both
management and non-management positions.

Background
The aim of this study seeks to identify patterns of behavior occurring daily in the perioperative setting.
It seeks to identify the main concern of nurses working there and how they resolve issues that arise.
Perioperative nursing can be defined as the provision of nursing care by a Registered Nurse
preoperatively (before), intra-operatively (during), and postoperatively (after) to a patient undergoing an
operative or invasive procedure. It is practiced today in many different areas, e.g. hospital operating
rooms, interventional radiology suites, cardiac catheterization laboratory (room in a hospital where
diagnostic imaging equipment is used to support the catherization procedures) surgeon offices,
endoscopy suites, ambulatory surgery centres and emergency trauma units. Perioperative nursing is a
complex and exciting specialty.

The Core Nursing Skills of Perioperative Patient Care involve: critical thinking, aseptic technique
(procedure performed under sterile conditions), working with diverse patients and evidence based
practice to ensure that quality care is delivered. It also involves maintaining safety, educating patients,
adhering to legal guidelines, policies and procedures’ ensuring that care is administered in an ethical way.
The fundamental nursing values (knowledge, skills, and judgment) are ever present when working in the
perioperative setting. These are the basis for quality care that surgical patients have relied on and can
expect when being cared for by any perioperative nurse. Perioperative nursing is not just technical work
that a nurse can do. A significant part of perioperative nursing is the delivery of scientifically based
care which involves understanding the need for certain methods of care and when to initiate them.
Knowledge of surgical interventions, instruments and equipment is required. Without this the
perioperative nurse is unable to prepare for or anticipate the steps in the surgical procedure. It must be
remembered that perioperative nursing is a systematic planned process. Many skills are required by
perioperative nurses, i.e. nursing care skills (assessment), interpersonal skills, critical thinking and
decision making and technical skills to ensure good quality care is given. Teamwork is fundamental in the
operating room and occurs from the moment one steps inside the unit. Participation in a multidisciplinary
team is part of working in the perioperative setting. Normally the perioperative period consists of the
preoperative, intraoperative and postoperative phase. The preoperative phase begins with the decision
to have surgery until the patient is transferred to operating theatre. The preoperative period is the
time period prior to surgery. The intraoperative period extends from admission to operating department
to the transfer to recovery room. The postoperative period extends from the admission to recovery
room to complete recovery from surgery. Surgery is normally classified under three headings: urgent
(which implies elective or emergency), risk (which implies minor or major) and purpose (which implies
diagnostic, removal, palliative, reconstructive, transplantation and constructive). Recent reconfiguration
changes within healthcare management in perioperative care have resulted in the movement of all major
and minor surgery to the larger city hospitals. Contributing factors include government policy, major
errors in diagnostic procedures, finance and creating centres of excellence.

Method
This study was guided by the principles of classical Grounded Theory, which is an inductive and
interpretative research methodology which creates research-based knowledge about behavioral pattern
as described by Dr Barney Glaser. Following ethical approval, data was collected through individual, face
to face, unstructured interviews with thirty seven perioperative nurses with varying lengths of
experiences of working in the area. Thirty three hours of observation was also undertaken within the
eight different perioperative settings within the Republic of Ireland. Theoretical sampling was utilized
for the study which enabled making a decision in keeping with the emerging data to identify new
participants to interview. Data was simultaneous collected and analyzed according to established classic
grounded theory research procedures of open and selective coding, constant comparison, memo-writing,
and theoretical sampling. The interviews were recorded and subsequently transcribed. The interviews
lasted between twenty five minutes to ninety minutes. During the initial interviews the nurses were
asked broad based open-ended questions regarding the challenges they face daily and they were listened
to without verbal interruption, thus ensuring that the researcher remained open to the data. As the
interviews continued, leads were followed and the questions became more focused while remaining open-
ended. Following interviewing of the participants, the interviews were coded using substantive coding
(open and selective) and constantly compared for similarities and differences. Memos were written in
varying lengths recording ideas, developing concepts, identifying and theorizing codes and their
relationships and hypothesizing about connections and relationships between categories. Memos were
then sorted and theoretical coding was undertaken as per classical grounded theory approach. This study
is current and the core variable to emerge from the study was minimizing risk in a high risk setting (main
challenge facing nurses in the perioperative setting). This challenge was resolved by the perioperative
nurses through “Anticipatory Vigilance”. This is now being written up in an explanatory theory.

Conclusion and Recommendations

 This study has provided the opportunity to nurses working in the perioperative setting to share their
experiences on how challenges in their work environment are encountered and resolved. There has been a
dearth of in-depth research within this area. The area of nurse perception of risk has been largely
unexplored to date. The findings from this study will provide valuable insight and awareness for nurses
working in the perioperative setting and provide a deeper understanding of the work undertaken by
nurses working in this acute setting for those working outside the setting. The theory identified in this
study will be relevant to a number of people both within and outside the perioperative setting. It is
hoped that this theory will support perioperative nurses with a clearer understanding of the work they
do and how they do it. It will add to the body of knowledge already available. It will support staff in
creating best practice guidelines ensuring that perioperative care is given further air time, resulting in
the perioperative setting being a safer place to work . This will lead to establishing better quality care
for all patients and nurses that spend time in the perioperative area. It is anticipated that this
explanatory theory will inform policy both locally and nationally in the future. It is current in adding to
the body of knowledge on risk management and assessment. It will inform and influence practice and
future understanding of nursing in the perioperative setting. Nurses working in the perioperative setting
have an important role in contributing to positive patient outcomes within the surgical setting and will
achieve that through influencing practice.

Brid O’ Brien (RGN, OND, Cert in Operation Theatre Technique, BNS, PG. Dip, RNT, MSc) is a lecturer in the Department of
Nursing and Midwifery at the University of Limerick and is also a student in the School of Nursing & Midwifery Brookfield
Health Sciences Complex UCC, under the supervision of Dr. Tom Andrews and Professor Eileen Savage

1. Make a synthesis on the salient points of the journal.

Perioperative nursing is defined as the care of the patient before, during and immediately after
surgery and has a rich history. Being at the frontline of care, the challenges and concerns
nurses continually face in their daily working lives impact on the care they deliver to the
patients in their care. The fundamental nursing values (knowledge, skills, and judgment) are ever
present when working in the perioperative setting. These are the basis for quality care that
surgical patients have relied on and can expect when being cared for by any perioperative nurse.
Perioperative nursing is not just technical work that a nurse can do. A significant part of
perioperative nursing is the delivery of scientifically based care which involves understanding
the need for certain methods of care and when to initiate them. Without this the perioperative
skills is unable to prepare for or anticipate the steps in the surgical procedure. It must be
remembered that perioperative nursing is a systematic planned process.

2. Reason for choosing the journal.

The reason I chose this journal because it helps the nursing education, practice and research to
understand and access it easily. The goal of this journal is to identify patterns of behavior
occurring daily in the perioperative setting and it seeks to identify the main concern of nurses
working there and how they resolve issues that arises and I this journal you will learn the
process of perioperative which are the preoperative, intraoperative and postoperative phase.
The preoperative phase begins with the decision to have surgery until the patient is
transferred to operating theatre. The preoperative period is the time period prior to surgery.
The intraoperative period extends from admission to operating department to the transfer to
recovery room. The postoperative period extends from the admission to recovery room to
complete recovery from surgery. In this journal you will learn more, enhance your skills and it
level up your functioning as student nurse particularly in operating room.

3. Expound the implication of the journal to the following:

A. Nursing Education

The implication of this journal to Nursing Education, it helps nursing students to understand
more regarding to the role of the nurses in perioperative and it also helps them to gain more
knowledge about the main challenges in perioperative nurses in caring of surgical patients. It
also enhance the skills and functioning of the student nurses in the physical care of surgical
patients, and a combination of different disciplines that both accelerates the patient's return
to health and helps maintain it. They can also acquire knowledge involving maintaining safety,
educating patients, adhering to legal guidelines, policies and procedures’ ensuring that care is
administered in an ethical way and acquire knowledge of surgical interventions, instruments and
equipment.

B. Nursing Practice

The relation of this article to Nursing Practice, it helps the practitioner to level up their
functioning and skills in giving care to surgical patients. This article was written to help nursing
practice to understand more in relevance of the main challenges in taking care of surgical
patients. Practitioners will identify patterns of behavior occurring daily in the perioperative
setting and it seeks to identify the main concern of nurses working there and how they resolve
issues that arise. It also enhanced their critical thinking, aseptic technique (procedure
performed under sterile conditions), working with diverse patients and evidence based practice
to ensure that quality care is delivered.

C. Nursing Research

The relevance of this article to nursing research, it helps the researchers to access and
understand it easily regarding on the challenges in taking care of surgical patients. Nursing
researchers develops knowledge about the main concern of nurses working in OR and how they
resolve issues that arises. The researchers will also learn the significant part of perioperative
nursing is the delivery of scientifically based care which involves understanding the need for
certain methods of care and when to initiate them. Research conducted by nurses includes
various types of studies in order to derive clinical interventions regarding on in assisting and
taking care of surgical patient’s .The complexity of nursing research and its broad scope often
require scientific underpinning from several disciplines.