The Patient Focused Model Of Perioperative Nursing Practice

Evidence based practice is an integral part of nursing care. According to the Academy of Medical-Surgical Nurses, evidence based practice is defined as, “the conscientious use of current best evidence in making decisions about patient care.” (AMSN) The use of evidence based practice has drastically improved patient outcomes, increased quality and safety of healthcare, and reduced costs for facilities. (Melnyk, 2016) In this paper I will provide the history of evidence based practice, how it has already been incorporated and impacted healthcare, and why it is important to nursing and healthcare as a whole.

5. Poulin,P., et al.(2014) Preoperative Skin Antiseptics for preventing surgical site infections: What to do?

The Joint Commission Accreditation Body assesses health care organization’s compliance with National Patient Safety Goals. The goal of the Joint Commission Body is to focus on critical aspects and patient safety issues in health care organizations, which can vary according to the setting of the health care being performed (Chassin, 2008). Infections occurring in surgical sites of patients account for 15% of all infections that transpire in a hospital setting, and the risk of death doubles in patients who develop infections. The dangers of surgical site infections include superficial, deep, and organ or space infections. The different infections include cellulitis, gangrene, MRSA, and wound sinus, which can lead to amputation, organ

In 1999, expert surgical nurse authors at the Association of periOperative Registered Nurses (AORN) developed a comprehensive curriculum to assist in the education and transition of nurses entering perioperative clinical specialty for the first time (Beyea, 2002). In 2007, Periop 101: A Core Curriculum (AORN, n.d.) was created which moved the instructor-based program into an online format of modules designed to assist with mastering core perioperative competencies. The program provides instruction with videos, assigned readings, and quizzes at the end of each module. The learning focuses on patient safety and the program is best utilized when combined with preceptorships and skills labs.

Professionalism in nursing has advanced greatly over the years. A cornerstone for change includes that of evidence based practice (EBP) as the drive of nursing intervention and patient care. According to the Quality and Safety Education for Nurses (QSEN), Evidence-based practice is described as the combination of the most recent evidence with clinical knowledge that includes the patient’s best interests in mind for greater patient outcomes (QSEN, 2017). The QSEN’s goal is to prepare nurses for improvement in quality and safety of patients (2017). Because of this goal, six competencies, including evidence-based practice, are listed for criteria of improvement in nursing practice (2017). I have been fortunate to have experience with implementing this practice and providing education in certain EBP protocols in my career. One EBP protocol in particular that our unit has been involved in since May of this year includes Enhanced Recovery After Surgery (ERAS) now referred to as Improving Surgical Care and Recovery (ISCR).

This assignment will reflect on the effectiveness of my clinical and interpersonal skills in relation to my position as a nurse in a busy critical care unit. It will primarily focus on one particular patient and the care they received by myself in their immediate post operative period. In accordance with the NMC’s code of professional conduct names will not be used to protect the patient’s confidentiality. NMC (2008).

Sharing information about the patient’s health status helps to create continuity of care between the medical staff and family members involved in the patients care. As stated in the textbook Leddy & Pepper 's Conceptual Bases of Professional Nursing (2014), “Patient-centered care was created in efforts to improve quality and safety in nursing and healthcare emphasizing the importance of patient-centered care, during which nurses use a holistic care approach considering each patient’s personal preferences, values, family situations, religious and cultural traditions, and specific life- style”

care outcomes, as well as benchmark data to assess current practice,” (Sherwood, 2014). American Nurses Association has a National Database of Nursing Quality Indicators looks for a cause for common healthcare issues, such as “surgical site infections, pain assessment, pressure ulcer development, and falls,” (Sherwood, 2014) to better understand how these things came about to possibly prevent in the future.

Permission was consented from the patient to use their condition for this essay; the information was accumulated from their admission, assessment and plan of care. The patient authorized usage of information relating to their period of hospitalisation in agreement that any personal information would not be used. This essay will address this matter in accordance with the Nursing and Midwifery Council (NMC) confidentiality guidelines set out in the Code of Professional Conduct (NMC, 2004). The pseudonym “David” will be used for this reason throughout this essay.

At a practice level, the importance and guidance of the Code of Conduct, Code of Ethics and NPA are demonstrated on a daily basis with regard to the issues of documentation, informed consent and open disclosure, and confidentiality. With respect to documentation, nurses must be able to document patient assessments and responses in an accurate, comprehensive and confidential manner and record all observations objectively. Informed consent and open disclosure are also major legal issues nurses face daily. It refers to the communication between the patient and health professional that results in the patient's agreement to undergo a specific procedure and requires that the patient has thoroughly understood the procedure, implications and risks prior to giving written consent.

By focusing on overall patient care and satisfaction many areas patients are surveyed on can be improved. Once a performance standard is selected staff must develop a plan for improvement. The first step would be to research as many sources as possible to find the best evidence based practices that would work for the specific facility. This can be divided into two the two categories of direct nursing care and indirect nursing care. Direct nursing care would include implementing hourly rounding, adequate nursing staff and SBAR communication. Indirect nursing care includes availability of technology such as wireless communication, real time locating, wireless monitoring, and electronic medical records. The second step would contain education of the staff on what is to be implemented and why. The why is important for nurses to overcome any barriers that might be encountered. While nursing practice has grown based on evidence Vanhook (2009) explains the greatest barriers to evidence based practice, such as difficulty interpreting findings, limited time, and misunderstanding of research itself, and how to overcome these barriers. With phase one and two completed facilities can move forward with implementation and evaluation.

In the physical realm of patient-centered care pain, comfort, sleep, and rest are important aspects of the fourth dimension of patient-centered care. Patient-centered care is the complete focus of the medical team on providing respectful care to meet patient needs, preferences and values guide decisions on each individual patient care. To understand the subjective view of the patient, these four aspects are at the forefront of their needs within the hospital setting to provide the best patient outcome. Nurses provide good patient-centered care by actively partnering with patients to determine care priorities and plans to tailor their level of involvement, according to their preferences, and being flexible by changing the care plan as the situation changes including providing smooth transitions between care goals. By doing this, nurses can assist patients with all pain by providing comfort and assuring the patient that there will be no deficiency of their quality of sleep.

Evidence-based practice (EBP) in nursing means making decisions about patient care on the basis of best, current, standardized practice and guidelines. According to an article, written by Dr. Kathleen Stevens, the development of evidence-based practice (EBP) is fueled by the increasing public and professional demand for accountability in safety and quality improvement in health care (Stevens, 2013). The author also mentioned in her article that the intended effect of EBP is to standardize healthcare practices to science and best evidence and to reduce illogical variation in care,

In healthcare, there is a functional and purposeful relationship that exists between the nurse, the doctor and the other interdisciplinary team. This relationship established by the healthcare team comes with a responsibility aimed at achieving a goal, which is to assist the patient to be able to gain independence and progress after hospitalization or rehabilitation. What is paramount to the healthcare team is focusing on the basic human needs of the patient gearing towards health which is a building block of health and wellness. With this being said, the writer chooses Virginia Henderson’s theory of needs because it gives an insight or guides the nurse for what to look for in caring for our patient’s needs with her 14 components of nursing care which still apply to modern nursing care and practice up till present day . As Licensed Practical Nurse (LPN) working in the Transitional Care Unit (TCU), her theory is made visible through my patient’s recovery process experienced every single day. “Henderson 's principles and practice of nursing fall under the category of grand theory that can be applied to many types of nursing” (Nicely & DeLario, 2011).

Those who incorporate the best practice standards can reduce the morbidity and mortality associated with surgical site infections.