Day surgery: Nursing’s contribution to this new surgical era

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Day surgery: Nursing’s contribution to this new surgical era

Larson, Melissa, Food Editor has reference to this Academic Journal, PHwiki organized this Journal Day surgery: Nursing’s contribution to this new surgical era Dr. Mark Mitchell Faculty of Health in addition to Social Care University of Sal as long as d Greater Manchester UNITED KINGDOM m.mitchell@sal as long as d.ac.uk +44 (0)161-295-6480 INTRODUCTION Throughout the expansion of day surgery, surgical nursing has largely shadowed medical advances. Consequently, medical developments have pre-determined many of the present day surgical nursing practices. Little or no ‘nursing knowledge’ has so far greatly influenced modern, adult day surgery practices (Pearson 2004). A perceived lack of modern surgical nursing issues in nurse education may be a contributing factor. Pearson et al (2004) The care of patients whilst in the day surgery unit: A systematic review. Health Care Reports. 2 p.22 – 54. Additionally, the vast majority of nurses employed within dedicated day surgery units in the United Kingdom work within a multi-skilled role. Predominately, this involves undertaking numerous delegated medical tasks (DoH 2000, 2004). Department of Health (2000) The N.H.S. Plan – Creating a 21st Century N.H.S. London: HMSO. Department of Health (2004) The N.H.S. Improvement Plan: Putting People at the Heart of Public Services. London: DoH. The adoption of such numerous quasi-medical tasks by the Profession is vital to ensure the safe in addition to efficient throughput of patients in the limited time available.

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However, such a change in surgical healthcare delivery has ensured a major shift of emphasis in surgical nursing intervention (Edwards 1996). Intermediate, elective surgical episodes once requiring lengthy hospital admission are fast disappearing from the in-patient ward, never to return. Moreover, the extensive physical care once required by such patients is diminishing. Edwards, N. (1996) The implications of day surgery as long as in-patient hospital wards. Nursing Times. 92 (37) p. 32 – 34. In 1999 the British Association of Day Surgery (Cahill 1999) recommended that at least 50% of all cholecystectomies should be possible in day-case facilities. Such innovation provides just one example of how the extensive physical pre in addition to post-operative nursing interventions once required by such patients are becoming obsolete in modern surgical practices. Cahill, J. (1999) Basket cases in addition to trollies: Day surgery proposals as long as the millennium. Journal of One-Day Surgery. 9 (1) p. 11 – 12. Moreover, if the wholesale adoption of delegated medical tasks continues, from where is the future of ‘true’ adult, surgical nursing intervention to originate Are we merely to persist with the indiscriminate accumulation of quasi-medical tasks in addition to re-label them as nursing intervention The aim of the study was there as long as e to evaluate the consideration given to modern surgical practices in the pre-registration programmes of study of recently qualified staff nurses employed within day surgery in the United Kingdom. The rationale being that new surgical nursing knowledge will not emerge while modern, surgical practices remain largely absent from programmes of study.

METHOD A postal questionnaire was sent to n=247 Day Surgery Units within the United Kingdom. All items on the questionnaire related to the inclusion of day surgery practices in nursing programmes of study. The questionnaire employed a Likert Scale as long as mat as long as most items. A response rate of 42% was achieved with data from a total of n=277 staff who became qualified nurses between 2000 – 2004. RESULTS 58% (n=158) of staff nurses surveyed did not have a day surgery clinical placement during their 3 year programme of study whereas 43% (n=119) did experience a day surgery placement. Day surgery placement However, 67% (n=186) experienced no theoretical input into modern day surgery nursing practices at any time throughout their 3 year nursing programmes of study. This is followed by 11% (n=31) who received one hour of day surgery theory. Collectively, this indicates that 79% (n=217) of staff nurses who responded to this survey experienced minimal theory relating to day surgery.

Theoretical input – day surgery focus Respondents were also invited to specify, which phrase best described the post-operative care taught. The majority (57% or n=158) indicated they had received traditional in-patient care only. The second largest group (28% or n=78) was in-patient in addition to out-patient post-operative care. There as long as e, 85% (n=236) of staff nurses here received no tuition regarding the post-operative management applicable to the modern, elective day surgery patient. Post-operative management – day surgery focus

77% (n=214) of staff nurses indicated they had undertaken no theoretical assignments relating to day-case surgery. This is followed by 20% (n=54) who had undertaken one such assignment. Collectively, this suggests that 97% (n=268) of staff nurses experienced minimal theoretical analysis in the as long as m of assignments in relation to modern day surgery. Assignments – day surgery focus The vast majority of respondents (94% or n=260) had undertaken their nurse education within the United Kingdom. Seventeen staff nurses (n=17) had qualified outside the European Union. Finally, respondents were asked to indicate what as long as mal programmes of education, specifically relating to day surgery had been undertaken since becoming a qualified nurse. 90% (n=248) had undertaken no as long as mal post-qualifying programmes specifically relating to day surgery.

Formal post-qualifying day-case surgery education RECOMMENDATIONS – Nurse Education in UK Over two-thirds of day surgery staff nurses who responded to this survey received no theoretical insight into the nursing challenges confronting day surgery. On a positive note, 43% of the staff nurses experienced a day surgery placement during their programme of study. However, with 85% experiencing no day surgery post-operative management, 79% virtually no theory in addition to 77% no specific assignments – is 43% gaining a placement truly concerned with day surgery enhancement or merely a convenient placement within a very congested United Kingdom clinical placement programme. Day surgery clinical placement

The staff nurses who responded to this survey were there as long as e manifestly not prepared during their pre-registration studies as long as their new roles within modern day surgery either clinically or theoretically. The emphasis within surgical nurse education must in future be reversed, that is, the majority of surgical nurse education should be more concerned with modern surgical practices in addition to patients who experience 24 hours or less in hospital. RECOMMENDATIONS – Clinical Nursing Roles 90% of staff nurses had undertaken no as long as mal education concerning day surgery since their pre-registration course although many stated they had made requests. The Profession must there as long as e petition as long as more nursing based post-qualifying courses as the trend as long as modern surgical nursing to constantly adopt devolved medical tasks in the United Kingdom must not continue to go unchallenged. In addition, prior to the future acceptance of student nurses within a Day Surgery Unit, clinical staff should question their Schools of Nursing regarding their day surgery theoretical component. The number of theoretical assignments encompassing modern, elective day surgery practices should also be questioned.

FUTURE of SURGICAL NURSING With the continued expansion of ambulatory surgery plus surgical nursing becoming increasingly competency based, two nursing challenges may arise – education in addition to future day surgery nursing intervention. Firstly, how will nurses be educated to undertake the competences as suggested (Moore 2003) – anaesthetic care ECG reading taking of blood samples cannulation, etc Moore (2003) No problem. Nursing St in addition to ard. 17(42) 16-17. This present study noticeably indicated that inadequate post-qualifying education is already an issue prior to any additional expansion. Without further action such training will invariably continue to be in as long as mal in addition to ad hoc Secondly, vital nursing issues remain a challenge, that is, pain management, psycho-educational intervention, nurse-led pre-assessment clinics in addition to post-operative care. With the planned expansion of day surgery such challenges are likely to increase if they remain unresolved. To conclude, the nursing profession must pursue the opportunities available during this new era of surgical intervention to extend nursing roles in addition to attain greater evidence-based, nursing knowledge. An increase in research into day surgery nursing must there as long as e be more widely considered. Not only can exp in addition to ed nursing roles then be further developed but more importantly, modern evidence-based nursing intervention, fit as long as the 21st Century can be acquired to help in as long as m future day surgery nursing practices.

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