The RN specializing in Perioperative Nursing practice performs nursing activities in the preoperative, intraoperative, and postoperative phases of the patients' surgical experience. Registered nurses enter perioperative nursing practice at a beginning level depending on their expertise and competency to practice. As they gain knowledge and skill, they progress on a continuum to an advanced level of practice.
Based on the Standards and Recommended Practices for Perioperative Nursing - A.O.R.N., the operating room nurse provides a continuity of care throughout the perioperative period, using scientific and behavioral practices with the eventual goal of meeting the individual needs of the patient undergoing surgical intervention. This process is dynamic and continuous, and requires constant reevaluation of individual nursing practice in the operating room.
The perioperative nurse is responsible and accountable for the major nursing activities occurring in the surgical suite. These include, but are not limited to the following:
* Assessing of the patient's physiological and psychological status before, during, and after surgery
* Identifying priorities and implementing care based on sound nursing judgment and individual patient needs
* Functioning as a role model of a professional perioperative nurse for students and colleagues
* Functioning as a patient advocate by protecting the patient from incompetent, unethical, or illegal practices during the perioperative period
* Coordinating all activities associated with the implementation of nursing care by other members of the health-care team
* Demonstrating a thorough knowledge of aseptic principles and techniques to maintain a safe and therapeutic surgical environment
* Directing or assisting with the care and handling of all supplies, equipment, and instruments, to ensure their economic and efficient function for the patient and personnel under both normal and hazardous conditions
* Performing as a scrub or circulating nurse as needed, based on knowledge and expertise for a specific procedure
* Participating in continuing education programs directed toward personal and professional growth and development
* Participating in professional organizational and research activities that support and enhance perioperative nursing practice
In 1978 the first description of perioperative nursing practice was presented to AORN members at the 25th National AORN Congress, stating: The RN specializing in Perioperative Nursing practice performs nursing activities in the preoperative, intraoperative, and postoperative phases of the patients' surgical experience. In addition to the newly defined role, the Nursing Practice Committee of AORN was charged with the responsibility of reviewing and revising the original standard to reflect the new dimension of the perioperative nurses' role. It is these standards that govern and guide the nurse when rendering patient care during the perioperative period. In 1982, the standards were revised as requested, and the definition of perioperative nursing practice was expanded to its current content, stating that perioperative nursing practice begins at an entry level based on clinical expertise and continues on to an advanced level of practice.
Perioperative nursing represents a multifaceted challenge to today's operating room nurse. In this role, the nurse has an opportunity to:
* Prepare the patient and family for surgery
* Provide comfort and support to patients and their family
* Use sound nursing judgment and problem-solving techniques to assure a safe and effective surgical experience.
Whether scrubbing, circulating, or supervising other team members, the perioperative nurse is always aware of the total environment, as well as the patient's reaction to the environment and the care given during all three phases of surgical intervention. The perioperative nurse is knowledgeable about aseptic technique, patient safety, legal aspects of nursing, and management of nursing activities associated with the specific surgical procedure being performed. OR nursing is unique: it provides a specialty service during the perioperative period that stresses the need for continuity of care and respect for the individuality of the patient's needs.
Perioperative nursing practice has one continuous goal: to provide a standard of excellence in the care of the patient before, during, and after surgery. As the only nonscrubbed member of the surgical team, besides anesthesia, the circulating nurse represents the coordinating link between the scrub team and all other departments and personnel associated with the surgical patient and the procedure. Other departments that may be involved in the patient's surgical experience include, but are not limited to, x-ray, pathology, blood bank, laboratory, blood gas lab, tissue banking, mammography, and radiation oncology.
The Circulating nurse, by virtue of her professional educational preparation and specialized skill, is responsible for managing patient care activities in the operating suite, so his/her duties begin long before the patient arrives in the operating room and continues until the final dispensation of the patient, operating room records, and specimens is completed.
The following list depicts some of the activities performed by the circulating nurse prior to induction of anesthesia and upon conclusion of the procedure:
* Assisting and preparing the procedure room
* Supervising the transporting, moving, and lifting of the patient
* Assisting anesthesia as requested during induction and reversal of anesthesia
* Positioning the patient for surgery
* Performing the surgical skin prep
* Conducting and maintaining accurate records of counts
* Maintaining accurate documentation of nursing activities during the procedure
* Dispensing supplies and medications to the surgical field
* Maintaining an aseptic and safe environment
* Estimating fluid and blood loss
* Handling special equipment, specimens, etc
* Communicating special postoperative needs to appropriate persons at the conclusion of the case
Operating room nursing is a highly specialized area of nursing that requires time and education for a registered nurse to realize her full potential in the surgical setting.
Beth Day, RN CNOR
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