PERI-OPERATIVE NURSING

DISAMPAIKAN OLEH
JUNIAR ERNAWATY, S.KP., M.KEP.., M.NG
 PERIOPERATIVE NURSING

SURGEERY

ANY PROCEDURE PERFORMED ON THE HUMAN BODY THAT USES INSTRUMENTS TO ALTER TISSUE
OR ORGAN INTEGRITY
 PERIOPERATIVE NURSING

• DESCRIBE FIVE DOMAINS OF THE PERIOPERATIVE NURSE

• DIFFERENTIATE THE ROLES AND RESPONSIBILITES OF PERIOPERATIVE NURSES
PERIOPERATIVE PROFESSIONAL PRACTICE

Researcher

Care educator
provider

Manager Professional
 NURSING PRACTICE
PREOPERATIVE PHASE

COLLECT DATA
IDENTIFY NEEDS • ASSESSMENT
DEVELOP PLAN OF CARE
COMMUNICATE NEEDS • NURSING DIAGNOSIS
• OUTCOME

OPERATIVE PHASE • IDENTIFICATION

COLLECT DATA • PLANNING

IDENTIFY NEEDS
• IMPLEMENTATION
• EVALUATION
PostOPERATIVE PHASE

COLLECT DATA
IDENTIFY NEEDS
 NURSING DIAGNOSIS
EXAMPLE
PERIOPERATIVE CARE
1. KNOWLEDGE DEFICIT RELATED TO PREOPERATIVE AND POSTOPERATIVE EVENTS
2. ANXIETY RELATED TO CHANGE IN HEALTH STATUS
3. RISK FOR INFECTION AND INJURY RELATED TO EXPOSURE TO NOSOCOMIAL INFECTION AND
USE OF PREOPERATIVE MEDICATION
 NURSING DIAGNOSIS
EXAMPLE
POST OPERATIVE CARE
1.IMPAIRED SKIN INTEGRITY RELATED TO DISRUPTION OF SKIN SURFACE
2. RISK FOR CONSTIPATION RELATED TO SURGICAL PROCEDURE AND ANASTHETICS
3. RISK OR FLUID VOLUME IMBALANCE RELATED TO INTRAVENOUS INFUSION AND NPO STATUS
4.IMPAIRED GAS EXCHANGE RELATED TO ANASTHETICS AND PAIN
5. PAIN RELATED TO SURGICAL PROCEDURE
6. RISK FOR IMPAIRED SKIN INTEGRITY RELATED TO LIMITED MOBILITY AFTER SURGERY
7. ANXIETY (CHILD & FAMILY) RELATED TO EQUIPMENT AND SURGICAL OUTCOME
9. KNOWLEDGE DEFICIT (CHILD AND FAMILY) RELATED TO NEEDED HOME CARE
 PERIOPERATIVE NURSING

• CONNOTES THE DELIVERY OF PATIENT CARE IN THE PREOPERATIVE,

INTRAOPERATIVE, DAN POSTOPERATIVE PERIODS OF THE PATIENTS
SURGICAL EXPERIENCE THROUGH THE FRAMEWORK OF THE NURSING
PROCESS. THE NURSE ASSESSES THE PATIENT-COLLECTING, ORGANIZING,
AND PRIORITIZING PATIENT DATA; ESTABLISHING NURSING DIAGNOSIS;
IDENTIFIES DESIRED PATIENT OUTCOMES; DEVELOP AND IMPLEMENTS A
PLAN OF CARE AND EVALUATES ACHIEVED BY THE PATIENT.
 PERI OPERATIVE NURSING
PHASES

• PREOPERATIVE PHASE—BEGINS WHEN THE DECISION TO HAVE

SURGERY IS MADE AND ENDS WHEN THE CLIENT IS TRANSFERRED
TO THE OR TABLE
• INTRAOPERATIVE PHASE—BEGINS WHEN THE CLIENT IS
TRANSFERRED TO THE OR TABLE AND ENDS WHEN THE CLIENT ID
ADMITTED TO THE PACU
• POSTOPERATIVE PHASE—BEGINS WITH THE ADMISSION OF THE
CLIENT TO THE PICU AND ENDS WHEN THE HEALING IS COMPLETE
 TYPES OF SURGERY
• PURPOSE/REASONS
• DEGREE OF URGENCY—NECESSITY TO PRESERVE THE CLIENT’S LIFE,
BODY PART, OR BODY FUNCTION
• DEGREE OF RISK—INVOLVED IN SURGICAL PROCEDURE IS
AFFECTED BY THE CLIENT’S AGE, GENERAL HEALTH, NUTRITIONAL
STATUS, USE OF MEDICATIONS, AND MENTAL STATUS
• EXTENT OF SURGERY—SIMPLE AND RADICAL
 TYPES OF SURGERY (PURPOSE)

• DIAGNOSTIC—ALLOWS TO CONFIRM OR ESTABLISHES DIAGNOSIS

• CORRECTIVE—EXCISION OR REMOVAL OF DISEASED BODY PART
• RECONSTRUCTIVE—RESTORE FUNCTION OR APPEARANCE TO TRAUMATIZED OR
MALFUNCTIONING TISSUE
• ABLATIVE—REMOVES A DISEASED BODY PARTS
• PALLIATIVE—RELIEVES OR REDUCES PAIN OR SYMPTOMS OF A DISEASE; IT DOES
NOT CURE
• TRANSPLAT—REPLACE MULTFUNCTIONING STRUCTURES
• COSMETIC—PERFORMED TO IMPROVE PERSONAL APPEARANCE
 TYPES OF SURGERY (URGENCY)

• EMERGENCY—PERFORMED IMMEDIATELY TO PRESERVE FUNCTION OR THE LIFE

OF THE CLIENT
• ELECTIVE—IS PERFORMED WHEN SURGICAL INTERVENTION IS THE PREFERRED
TREATMENT FOR A CONDITION THAT IS NOT IMMINENTLY LIFE THREATENING OR
TO IMPROVE THE CLIENT’S LIFE
• URGENT—NECESSARY FOR CLIENT’S HEALTH TO PREVENT ADDITIONAL
PROBLEM FROM DEVELOPING; NOT NECESSARILY AN EMERGENCY
• REQUIRED—HAS TO BE PERFORMED AT SOME POINT; CAN BE PRE-SCHEDULED
 TYPES OF SURGERY (DEGREE OF RISK)

• MAJOR—INVOLVES A HIGH DEGREE OF RISK

• MINOR—NORMALLY INVOLVES LITTLE RISK
• AGE-VERY YOUNG AND ELDER CLIENTS ARE GREATER SURGICAL RISKS THAN
CHILDREN AND ADULT
• GENERAL HEALTH—SURGERY IS LEAST RISKY WHEN THE CLIENT’S GENERAL
HEALTH IS GOOD
• NUTRITIONAL STATUS—REQUIRED FOR NORMAL TISSUE REPAIR
• MEDICATION—REGULER USE OF CERTAIN MEDICATIONS CAN INCREASE
SURGICAL RISK
• MENTAL STATUS—DISORDER THAT AFFECT COGNITIVE FUNCTION
 THE ROLE OF THE NURSE AND THE PREOPERATIVE
ASSESSMENT IN PATIENT TRANSITIONS
(1) UNDERSTANDING PATIENT VULNERABILITIES
(2) MULTIDIMENSIONAL COMMUNICATION
(3) MANAGING PATIENTS’ EXPECTATIONS
(4) NURSING’S ROLE IN COMPENSATING FOR GAPS

CONCLUSION: THAT THE NURSE’S ROLE IN THE PREOPERATIVE ASSESSMENT DURING THE
TRANSITION OF PREOPERATIVE CARE IS THAT OF ADVOCATE WHO IDENTIFIES THE PATIENT’S
NEEDS AND RISK FACTORS THAT MAY BE AFFECTED BY THE SURGICAL EXPERIENCE
• HISTORICALLY—THE FOCUS OF A PREOPERATIVE ASSESSMENT HAS BEEN TO EVALUATE A
PATIENT AND IDENTIFY PROBLEMS THAT MAY PUT THE PATIENT AT HIGH RISK FOR POOR
SURGICAL AND ANESTHESIA OUTCOMES. ADDITIONAL GOALS OF THE PREOPERATIVE
ASSESSMENT ARE TO IMPROVE QUALITY OF CARE AND RESTORE THE PATIENT TO THE DESIRED
LEVEL OF FUNCTION
• WHEN PATIENTS TRANSITION INTO THE PERIOPERATIVE ENVIRONMENT OF CARE, THEIR NEEDS
CHANGE DRASTICALLY. THE SURGICAL PATIENT IS MORE VULNERABLE TO TRANSITION-IN-CARE
ERRORS OR COMMUNICATION LAPSES BECAUSE OF THE NUMBER OF TIMES THE PATIENT
TRAVELS ACROSS SITES OF CARE THROUGH THE PREADMISSION, INTRAOPERATIVE, AND
POSTOPERATIVE PHASES
• FOR ELECTIVE PROCEDURES, THE FIRST TRANSITION IN CARE IN THE PERIOPERATIVE
ENVIRONMENT COMMONLY OCCURS AS PATIENTS TRANSFER FROM THE CARE OF THE
COMMUNITY-BASED PRIMARY CARE PHYSICIAN TO THE SURGEON.
INITIAL PREOPERATIVE PATIENT MEETINGS WITH THE PERIOPERATIVE CARE TEAM THAT INCLUDE THE
SURGEON, ANESTHESIA PROFESSIONAL, AND NURSE AMONG OTHER CARE TEAM MEMBERS ARE IDEAL
FOR PREPARING SURGICAL PATIENTS AND COORDINATING CARE. PATIENTS VIEW THE PREOPERATIVE
VISIT AS BENEFICIAL IN THAT IT PROVIDES NECESSARY INFORMATION AND CLARIFIES EXPECTATIONS
RELATED TO THEIR PERIOPERATIVE COURSE OF CARE EARLY IN THE CARE TRAJECTORY. THE NEED FOR
SURGICAL INTERVENTION IS DETERMINED DURING THE INITIAL SURGICAL EVALUATION. THE
ANESTHESIA EVALUATION ESTABLISHES AN ANESTHESIA ASSESSMENT AND RISK STRATIFICATION FOR
CARE ACROSS THE PERIOPERATIVE ENVIRONMENT

AFTER THE SURGICAL PROCEDURE, THE INTRAOPERATIVE CARE TEAM COMMONLY PROVIDES THE POST
ANESTHESIA CARE TEAM WITH A REPORT OF THE PROCESSES THAT OCCURRED DURING THE
SURGICAL PROCEDURE. THE POST ANESTHESIA NURSING CARE TEAM INITIATES THE TRANSITION OF
CARE TO THE POSTSURGICAL NURSING TEAM WHO TYPICALLY CARES FOR PATIENTS ON SURGICAL
CARE UNITS AND ULTIMATELY PREPARES PATIENTS FOR THE TRANSITION TO HOME (WITH OR
WITHOUT HOME CARE SERVICES) OR TO ANOTHER CARE FACILITY.
THE PREOPERATIVE ASSESSMENT IS ONE OF THE CRITICAL POINTS OF CARE FOR PATIENTS
TRANSITIONING INTO THE PERIOPERATIVE ENVIRONMENT. MUCH OF THE PERIOPERATIVE SAFETY
LITERATURE GENERALLY SPEAKS TO COMMUNICATION FAILURES IN THE OR AND IN THE
POSTOPERATIVE HAND OVER. IN CONTRAST, ONE STUDY BY NAGPAL ET AL1 POINTS TO
SUSCEPTIBILITIES IN THE PREOPERATIVE PHASE AND DETERMINED THAT OR TEAM MEMBERS HAD
VARYING AMOUNTS OF KNOWLEDGE OF THE PATIENT AND ONLY 27% OF THE TOTAL PATIENT
MEDICAL INFORMATION WAS KNOWN TO ALL THE PRIMARY TEAM MEMBERS IN THE OR (IE,
SURGEON, ANESTHESIOLOGIST, SURGICAL ASSISTANTS, SCRUB PERSON, RN CIRCULATOR)

TRANSITIONS IN CARE IN THE PERIOPERATIVE AREA ARE NUMEROUS AND SHOULD BE VIEWED AS
HIGH-RISK ENDEAVORS. IT IS WELL DOCUMENTED THAT DEFECTIVE TRANSITIONS PLAY A ROLE IN A
MAJORITY OF SERIOUS MEDICAL ERRORS; HOWEVER, FEW STUDIES ADDRESS WHY THIS HAPPENS. IN
CONTRAST TO MUCH OF THE LITERATURE REGARDING HAND OVERS THAT DEFINE AND
ACKNOWLEDGE THE SAFETY RISKS INHERENT IN TRANSITIONS IN CARE, SMITH ET AL CONSIDERED THE
ISSUE OF TRANSFER OF PROFESSIONAL RESPONSIBILITY FOR THE PATIENT IN THE CONTEXT OF A
HAND OVER OR TRANSITION, REVEALING HOW AND AT WHAT POINT RESPONSIBILITY IS ACCEPTED
“DEPENDED ON INDIVIDUAL INFORMAL NEGOTIATION BETWEEN NURSE AND ANESTHETIST AND
APPEARED TO INVOLVE MUTUAL TRUST, DIFFERING EXPECTATIONS AND THE BALANCE OF POWER IN
THE RELATIONSHIP.
MODEL OF FAMILY-CENTERED PEDIATRIC PERIOPERATIVE CARE
• PROPOSED MODEL OF FAMILY-CENTERED PEDIATRIC PERIOPERATIVE CARE. THIS MODEL
HIGHLIGHTS IMPORTANT COMPONENTS OF CARE IN THE PREOPERATIVE PERIOD (PREPARATION
FOR SURGERY), IN THE INTRAOPERATIVE PERIOD (MANAGEMENT STRATEGIES), AND IN THE
POSTOPERATIVE PERIOD (PAIN MANAGEMENT AND RECOVERY AT HOME). IN ADDITION TO
NOTING COMPONENTS OF CARE, THIS MODEL ALSO IDENTIFIES POTENTIAL FAMILY AND
HEALTHCARE PROVIDER OR SYSTEM VARIABLES THAT CAN AFFECT THE WAY IN WHICH FAMILY-
CENTERED CARE IS DELIVERED. THE FACTORS SUCH AS PARENTS’ AND CHILDREN’S ANXIETY,
FAMILY HISTORY WITH MEDICAL PROCEDURES, AND PARENTS’ AND CHILDREN’S COPING
STYLES AND PREFERRED COPING STRATEGIES SHOULD BE TAKEN INTO ACCOUNT WHEN
DELIVERING FAMILY-CENTERED CARE. PROVIDER CHARACTERISTICS SUCH AS TRAINING IN
WORKING WITH CHILDREN AND FAMILIES, AND COMMUNICATION AND INTERACTION STYLE
WILL ALSO AFFECT HOW WELL THESE STRATEGIES CAN BE IMPLEMENTED, AS WILL SYSTEMIC
FACTORS SUCH AS ORGANIZATIONAL POLICIES AND ADMINISTRATIVE SUPPORT FOR
FAMILYCENTERED CARE.