E-portfolio

Module 1 – Teamwork (understanding the roles of individual members in the OR)

In this module, teamwork is the topic that is considered in the context of the perioperative nurse and their role in surgery. Teamwork is crucial in surgery and a high performing team has:

· clearly defined leadership roles, particularly in critical situations;

· a leadership style that minimises status and power differences;

· a style appropriate to the particular situation;

· leaders who continuously solicit input from team members and engage in team-based decision making;

· leaders who are flexible enough to modify their approach and objectives as new conditions change (Royal College of Surgeons, 2014).

Based on what you have explored in Module 1 about teamwork, communication and the role of the perioperative nurse, discuss the scenario below and explore how teamwork and effective communication is crucial to the successful outcome for the patient undergoing surgery.

Scenario description

An operating list has started early in the morning at a busy metropolitan hospital. An operating team begin their list of orthopaedic (musculoskeletal) operations.

A perioperative (circulating) nurse enters the operating room to offer morning breaks for the nursing staff. The nurse notices the atmosphere is a little tense and the surgeon is making sarcastic quips.

The surgical procedure has just begun. The scrub nurse stands on a step stool and she has two instrument tables ahead. She is going to jump down off the stool if she has to reach the instruments on the tables behind her. The surgeon asks, “Do you have a scalpel?” and the scrub nurse answers, “Yes, here” The surgeon asks, “Do you have scissors” (he gets the instruments). The surgeon asks again, “Then, I must have a suture to close the incision!” The scrub nurse replies with a question, “closure for the skin?” and the surgeon answers, “Yes!” The surgeon continues, “Can I get a chisel?” The nurse is searching on the tables in front; she jumps down the stool and searches on the tables behind. The surgeon is waiting, and after a little while he says loudly, “The nurse can’t find the chisel.” After waiting a little longer, he continues, “The fact that she cannot find it, I view as a sign that she doesn’t know what she is doing!”

The scrub nurse is quiet, and she finds the chisel. The operation goes on the same way for a few more minutes. Finally, the surgeon says, “Wouldn’t it be easier if you rolled the tables to me?” The scrub nurse answers, “I didn’t expect you to use those instruments at the same time!” Now the relieving nurse intervenes and says sarcastically, “Isn’t he nice to you, Felicity!” [She mentions the first name of the scrub nurse]. Halfway through the surgical procedure, the surgeon exclaims loudly, “This is a mess!

Module 2 – Environmental Aspects and safety (O H and S)

The ability to track instruments and trace patients is integral to patient safety and risk management. Explore and discuss ‘Tracking and Traceability’, addressing the following questions:

What is ‘tracking and traceability’?
Why is this process important?
What methods can be used?
What are the impacts to the patient if this is not followed?
How would you like to improve your knowledge of this area?

Use relevant sources and examples to illustrate your points.

Module 3 – Surgical Risks

Surgical patients are vulnerable and at risk of many potential problems, many of our patients have co-morbidities or bring with them ‘risk’ prior to any surgical intervention. Consider that patients further increase their risk by entering the perioperative environment, undergoing anaesthetic, their condition or reason for surgery; add to that trauma due to the surgical procedure and you can see why the perioperative environment is considered to be a high risk environment for any patient.

Select a risk factor and discuss how this risk factor can have impact on the patient in the surgical setting; and how as a perioperative nurse we plan for or mitigate risk in our ‘plan of care’ for our patients. Your chosen risk could be an environmental, health, education or social risk, and you must provide rationale as to ‘why’ this is a considered risk.

Module 4 – Considerations of the role of the Perianaesthetic and Post-anaesthetic care unit (PACU) nurse/Recovery Room nurse Intra and Post-Operative Patient Safety

It is important that those working in the perioperative setting have a consideration of the different environments of the perianaesthetic nurse and the recovery room/post-anaesthetic care (PACU) nurse in order to understand their role in the surgical team and their integration of care to the patient undergoing surgery.

Research and discuss the role of the perianaesthetic nurse in the intra-operative period using the categories below. Please relate the immediate patient care conducted by the recovery room/post-anaesthetic care (PACU) nurse in the post-operative period of the patient journey.

Include any care considerations related to the patient emerging from anaesthesia (primary, secondary and tertiary assessment; AVPU/pain scale) and the discharge from the PACU providing rationale as to the patient care required.