CHAPTER 1

Introduction

The health care delivery system is the totality of services offered by all health disciplines.
Previously, the major purpose of the health care system is to provide care to the ill and injured.
However, with increasing awareness of health promotion, illness prevention, and levels of
wellness, health care systems are changing, so as the roles of nurses in these areas (WHO, 2008).
In the same manner that the health care delivery system has evolved into what it is now; to
heed the call for an action towards the current adversities of the time, so has the Nursing
practice been influenced by the changing global and local health trends. These national and
international imperatives brought nursing into new frontiers and have positioned nurses to
emerge as leaders in health promotion and advocacy.
Nursing comes in various forms in every culture (M. Leininger, 1995); the definition of the
term may be universal, so as the aim. According to the International Council of Nurses, nursing
"encompasses autonomous and collaborative care of individuals of all ages, families, groups
and communities, sick or well and in all settings. Nursing includes the promotion of health,
prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a
safe environment, research and education are also key nursing roles" (ICN, 1987).
In the last few decades, the complexities of surgeries have increased greatly (Al-Radi OO,
Harrell FE, Caldarone CA, McCrindle BW, et al, 2007). As a result, surgery has become a common method of
treating diseases and promoting health. Many surgical procedures that were once performed in
an inpatient setting now take place in an ambulatory or outpatient setting. This trend has
increased the acuity and complexity of surgical patients and procedures. All surgical procedures
can potentially affect a persons functional abilities. The impact can be great and permanent or
brief and temporary.
Perioperative nursing is the care of clients during their [clients] surgical experience. It
demands precise understanding of the knowledge and skills in perioperative care and also
requires an in-depth apprehension of related disease processes that have brought the client to
seek treatment (JQ Udan, 2009). The goal of perioperative nursing practice is to assist every
individual involved in the care of clients to help achieve a level of wellness tantamount to or
even greater than to which they had before the procedure. This requires prudent application of
the nursing process and allows for multiple nursing roles.
Surgery is a complex team task with a considerable number of members taking part in
the patient care chain. By the time a patient enters the operating room the amount of data
accumulated for even a healthy young patient is enormous. Nurses are frequently not familiar
with all of the available data and may be only partially informed about the surgical plan
(Roth EM, Christian CK, Gustafson M; et al, 2004). Subsequently, adverse events and errors may
occur. About one-half of hospital adverse events are associated with surgical procedures
conducted in the operating room (Leape LL, Brennan TA, Laird N; et al. The nature of adverse events in
hospitalized patients. Results of the Harvard Medical Practice Study II, N Engl J Med). Surgical complications
and adverse outcomes have been linked to lack of communication and coordination among
surgical teams. Communication breakdowns may lead to conditions in which team members
are uninformed or misinformed (Lingard L, Espin S, Rubin B; et al., 2005). Errors as such must then
be addressed and scientifically resolved to ensure safety of the client.
Communication, one which is effective, among nurses is a vital tool for the delivery of
care (Kirkley, D., & Stein, M., 2004). It follows a well organized flow to ensure the adequate
exchange of ideas and thoughts among nurses and other health personnel involved in the care
of the clients. It is then imperious to practice and develop an efficient and effective process to
communicate vital and sound information.
Poor communication is the single most frequent cause of adverse events across all
facets of health care, resulting in problems that range from delays in treatment to medication
errors to wrong-site surgery (JCAHO: SES, October 14, 2007). Errors as such must then be addressed
and considered earnestly for further understanding. Likewise, better research and study must
be in-place and is an imperative to retaliate such strain to further advance the level of care
provided by health disciplines, specifically nurses. Although the imperative to avoid such errors
is widely acknowledged, (JC: national patient safety goals, December 2005) progress has been slow.
Therefore, various initiatives to improve the quality of care across medical specialties have
sought to improve communication within clinical teams (Leape LL, et al, JAMA 2005). Many studies
of such initiatives have documented a perception of improvement of the care team regarding
collaboration, understanding of clinical goals, teamwork, and communication (Awad SS, Fagan SP,
et al, AM J Surg, 2005). Application of an effective process must then have implications of
astronomical values to improve health care delivery and patient outcome.
When considering the process of communication Zajonc & Adelman (1987 p. 3) suggest
that one should automatically consider the way in which that information is processed; There
cannot be any form of communication without the transmission of some content, and that
content must necessarily have cognitive origin. At the point of reception too, a cognitive
process must be engaged to encode the transmitting signals. Cognitive processing refers to the
mental processes which occur within the individual, so that they can perceive, understand and
act upon the information around them. Therefore, one could suggest that the communication
of information during a preoperative briefing/conference and the cognitive processes which
both the nurses giving the communication and those receiving it employ, are inextricably
linked.

In an attempt to improve team communication and reduce adverse events in surgery
that can be linked to lack of information, several safety agencies have proposed the
introduction of preoperative briefings that focus primarily on verifying key identification details
(Lingard L, Espin S, Rubin B; et al., 2005). This is helpful, but it is only part of the information
required to be presented and verified to allow effective teamwork and enhance patient safety.
This then calls for the development of a more detailed process of briefing where nurses discuss
a more detailed stance relating to, and not only exclusive to the patient himself, but also the
ever changing proclivity of doctors, surgical techniques and more. Giving the nurses a room to
acknowledge and discuss relevant information to prudently, efficiently, and effectively
participate during the intraoperative phase.

Client safety remains the primary and a constant goal for all health disciplines. It must
be considered at all aspects of care. Developing a tool that can enhance the accuracy of care
provided by nurse to clients can dramatically impact the level of wellness and ensure safety to
our clients. This leads us to the understanding of such need and the improvement of
communication and efficiency during the operative experience of the client. With nurses having
the natural propensity to inquire regarding such matters and address them is a great leap for
the profession. Setting a new standard of care during the preoperative, intraoperative and even
the postoperative phase of the science of perioperative nursing. Imploring each nurse to
prudently discuss and acknowledge the ever changing preferences of doctors, surgical
techniques, and to strategize patient management with his co-nurse.

Today, as a result of advances in surgical techniques and instrumentation, it is not but
imperative to address the nursing needs of clients but also the roles and tasks of nurses during
the intraoperative phase. This is to increase efficiency and hence improve patient outcome.
Suggestive of this, like a change of shift report, a perioperative conference among nurses
involved in the care is quintessential to discuss the ever changing preferences of doctors,
surgical techniques, and to strategize patient management. This leads us to the understanding
of the importance of a preoperative conference among nurses to discuss patient information,
preferences of doctors, operative technique and patient care management to assure quality
care and better outcomes for patients.

A nurse-focused preoperative briefing wants to realize an increase in the efficiency of
care and relevantly decrease the errors associated with poor communication. Strives to address
such errors has proven insufficient and it is but time for the profession to address these
disparities rooting from unsatisfactory communication. It is high time to acknowledge and
develop a more effectual manner usable and implementable to nurses, here and globally.

Competence is not only the basis of an effective nursing care, but also patient outcome.
An increase in the awareness of clients with the promotion of wellness requires nurses to be
more responsive to such need and promptly answer with great tenacity and compassion.

Sources:
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