Learning Outcomes Assessment for Student Nurse

information conclusions Assessment for Student confineLearning Outcome 1 Pre-assessmentThe ultimate goal of the pre-assessment is to get wind that those perseverings set as suitable for sidereal day cognitive offshoot be properly get a line while those considered unsuitable for a selected procedure atomic number 18 identified primaeval enough in the process to deliver for other treatment options ( bailiwick health operate, n.d.a, p. 13). Although ultimately it is a joint decision amidst the surgeon and anesthetist who make the final determination (National wellness go, n.d.b), the nurse plays a racy use of goods and services in the process and should be involved in the option criteria ( violet College of Nursing 2004, p. 1). Pre-assessments of unhurrieds scheduled for day performance are usu whole toldy performed by an outreach nurse from a day operating room centre, by telephone screening, or by questionnaire (National Health renovations, n.d.a, p. 9) or via appointments with day surgery staff or in vary pre-admission clinics (Joanna Briggs Institute 2004, p.2).Many institutions are combining pre-assessment interviews with the luck to work with the longanimous in a preoperative education berth in order to decrease longanimous anxiety, assess the needs of the forbearing and/or family members and to personalise information (Joanna Briggs Institute 2004, p.2). The National Health Services (n.d.a, p. 11) states this is an effective fortune to too discuss the functional procedure in greater detail with the uncomplaining, grade special requirements for admission, surgery and/or rout out and all toldow the patient to choose their own date for surgery, finalizing and/or conniption the appointment.According to the Royal College of Nurses (2004, p. 3), nurses performing the pre-assessments prerequi lay have the option of macrocosm able to contact the anaesthesiologist of surgeon if a fuss is identified that could electromot ive forcely increase the risk during anaesthetic or surgical intervention. This is critical otherwise, in that location is no apparent reason for the assessment if the nurse cannot raise her concerns.The National Health Services (n.d.a, p. 9) day surgery postulatelines state pre-assessments performed as shortly as possible pursuit the surgical consultation can allow for treatment of chthonianlying physical issues that might preclude them from the day surgery procedure, such as high blood pressure and/or dress out for home perplexity. If this is not possible, the National Health Services (n.d.a., p. 13) recommends that patients should then roll in the hay a health-screening questionnaire before leaving the outpatient department.According to the National Health Services (n.d.a., p. 11), incorporating the pre-assessment step in the day surgery process has been shown to reduce surgical cancellations and increase communication across the multidisciplinary aggroup.Based on resear ch, it is of the essence(p) to denounce that the day surgery pre-assessment is a valuable tool that can patron the patient, the perioperative and surgical nursing teams as well as surgeons and anaesthesiologists. The pre-assessment is a representation of initiating a comprehensive set of documentation for the entire team.Learning Outcome 2 Effective communicationAccording to the Joanna Briggs Institute (2004, p. 4), caseload can determine the staffing mix required. The staffing mix for a day surgery centre, however, can pull up stakes from a group of individuals who work together on a fixing basis such as the case in a specialized clinic linguistic context to a group of individuals who rely on departmental breach staffing for perioperative nurses and surgical nonmigratorys in a busy teaching hospital. No field what the group mix is, however, the need for communication is critical to patient feel for in all conniptions, especially surgical, where according to Cowen et al . (2005) communication is especially contend for workers in environments that are high stress and time sensitive. Vazirani et al. (2003, p. 72) states that improving the take of quislingism, not just communication, can enhance job satisfaction among health check professionals while increasing the quality of get by and patient satisfaction.While traditionalistic communication techniques such as active listening, positive voice tone, and reiteration to confirm bring ining are desirable goals, in the surgical setting other barriers often compound communication problems, including status and posturing between doctors versus the communication found between doctors and nurses or nurses and nurse practitioners. Vazirani et al. (2003, p. 72) discuss the cautiousness nurse practitioners took not to violate the autonomy of residents or interns and did not nurse patients on their own or write orders without the consent of a resident or an intern.Essential to a multidisciplinary team is the need for collaboration, where decision- qualification is a dual-lane event for doctors and nurses and that open communication between the two professionals exists (Vazirani et al. 2003, p. 73). It is important to note that research demonstrates physicians view collaboration antithetically than nurses, such that physicians believe collaboration implies cooperation with follow-through pertaining to following orders rather than sharing in the decision making process (Vazirani et al. 2003, p. 75). Vazirani et al. (2003, p. 76) also cited nurses as not being provided timely or accurate information regarding patient information when physicians autonomously make a deepen in their normal protocol, stating nurses need the information most as they are the ones at the patients bedside.Communication is a commonly sited problem and is one that, despite all the best suggestions and recommendations, from outlining roles and responsibilities, collaborating as a team or mutual team member s each afforded appropriate professional admire (Vazirani et al. 2003) to developing Integrated alimony Pathways (ICPs) as outlined by pekan and McMillan (2004) is difficult to remedy. Ultimately, human emotions and professional pride create unnecessary clangor that discourages open communication for fear of reprisal. Cowen et al. (2005) emphasize the need for an accurate scarper of information between various disciplines as the most critical panorama in order to assure patient safety.Learning Outcome 3 enduring selection criteriaPatient selection criteria primarily focus on three primary factors surgical, medical and brotherly (National Health Services, n.d.a, p.11 National Health Services, n.d.b.). Surgical criteria assess whether the procedure leave leave the patient pendant on others and/or if it has a statistically significant postoperative unwholesomeness level. The National Health Service (n.d.b.) states that the surgical procedure should take less(prenominal) tha n 1 hour, involve minimal blood loss, be unlikely to green groceries severe post surgical upset or nausea and be unlikely to result in a loss of physical independence.When assessing social appropriateness, according to the Association of Anaesthetists of Great Britain and Ireland (cited by Joanna Briggs Institute 2004, p. 2), the pre-screening interview is an opportunity to assess the patients willingness to have surgery, the certainty of self-aggrandising care in the home following surgery, telephone entrance and taking into affection the patients home situation. For example, are there several untested children and toddlers or infants at home requiring constant care is the only adult available to help the patient an elderly or frail individual, or has the patient stated they feel they are being pressured into having the surgery. These are all reasons that should be presented to the surgeon, anaesthesiologist and the rest of the multidisciplinary team as reasons the patient sho uld be precluded from day surgery. redundantly, patients with a social history of significant levels of alcohol consumption and/or who smoke are indications of potential preclusion or the need for spare counselling earlier to surgery (National Health Service n.d.b.). The Royal of College of Nurses (2004) also states that the patient must have the availability of an escort home following surgery and that the travel time home must be inwardly one and a half hours and if small children are present in the home that a phencyclidine hydrochloride is available specifically to tend to the children.Medically, it is important to assess cardiac fitness, assurance of height/weight appropriateness and if they are physiologically under 70 years of age1. Exclusions are usually automatic rifle if there is uncontrolled hypertension, recent history of cardiac failure, pregnancy, angina, asthma, diabetes or epilepsy. Additional issues that require notification of the appropriate medical personnel include foregoing difficulties with anaesthesia or current medications that would either preclude day surgery or require either a modification and/or pro tempore cessation of the pharmaceutical agent, particularly warfarin.The American parliamentary procedure of Anaesthesiologists (ASA) (cited by The Royal College of Nursing 2004) uses three classifications to assess physical statusClass 1 patient is mentally and physically fit and the surgical procedure is situate without systemic disruption, for example, removal of a uterine fibroid in an otherwise full-blooded female or the repair of an inguinal hernia in a healthy individual.Class 2 patient suffers from kookie to moderate systemic pathology that is either cause by the pathology to be treated by the day surgery or by other pathology, for example anaemia or mild diabetes or slightly limiting organic heart disease.Class 3 patient suffers from a severe mental or physical unsoundness from whatever cause, such as angina pector is, moderate to severe levels of pneumonic insufficiency, vascular complications from severe diabetes or significantly limiting heart disease.Criteria used for patient evaluation and assurance of fitness for day surgery as outlined above are focused primarily on the suitability for general anaesthesia without complication. It is essential however, to couple both the individual patient status as provided by the pre-assessment with the type of surgical intervention proposed. The medical professional cannot use the same set of pre-assessment criteria for all patients for all procedures they must simply be a guide. For example, physiological trauma, anaesthetic requirements and post-operative pain are different for those having arthroscopy as opposed to a laparoscopic cholecystectomy or partial thyroidectomy. totally three are considered day surgical procedures by the Royal College of Nurses (2004, p. 2).Patient selection criteria are important for nurses to consider from many aspect s. The nurse has to understand the physicians reason for suggesting day surgery for their patient, she needs to understand the surgeons belief in appropriateness and she has to understand the potential risks that are often overlooked by physicians and surgeons that now become her indebtedness to ascertain. Although it is often a delicate position for the nurse to be in, it is essential that she bring to the surgeon or anaesthesiologists attention any patient not appropriate for day surgery. This is an issue of legal liability for all professions on the multidisciplinary team and for the clinic or hospital as well as one of ethical concerns for the patients overall care and wellbeing.Learning Outcome 4 Pain focusAccording to Lipp and Yap (2005, p. 64) prior to 2003, the responsibility for post-surgical pain was the sole responsibility of the anaesthesiologist and no routine or regular pain assessments were conducted. In 2003, pain charge assessments and the nursing role in pain ma nagement in the day surgery setting became the standard. The Royal College of Anaesthetists (as cited by Lipp Yap 2005, p. 64) tell us that following a day surgical procedure, less than five percent of all patients should get laid severe pain while up to 85 percent will have mild or no pain following surgery. Beauregard et al. (1998, p. 309) believes that it is not unusual for pain to persist during the entire week following surgery, nevertheless that the best predictor of significant post-surgical pain following hospital poke was inadequate pain control during the first few hours of following surgery. look has acknowledged that the longer an individual is experiencing pain that is not attended to or interrupted in some way, the more sensitive to painful stimuli the patient becomes (Mukherji Rudra 2006, p. 355). Ultimately, the goal of effective post-surgical pain management is to be safe and effective, catch minimal side effects such as nausea.It was stated that the criteria for patient selection should be individualized based on patient status and type of surgery. Similarly, Mukherji and Rudra (2006, p. 355) state that patients should be identified as potentially at risk based on age, physical status, presence of pre-existing pain, site and extent of surgery. Additionally, researchers believe that the amount of postoperative pain a patient experiences is also a factor of the surgeon and surgical techniques used ( Mukherji Rudra 2006, p. 356 Chung et al. cited by Beauregard et al. 1998, p. 305). Mukherji and Rudra (2006, p. 355) discuss several pain assessment tools the visual analogue plate (VAS) where pain is rated along a continuum from no pain at all to the worst pain imaginable and the Ouchers scale for children. Many patients themselves denigrate post-surgical pain for reasons ranging from believing that pain is part of the natural recovery process and what they are experiencing is normal (Beauregard et al. 1998, p. 209).Post-operative pain man agement can take different forms, including pre-emptive analgesia and prophylactic analgesia (Mukherji Rudra 2006, p. 356). There are also pharmacologic and non-pharmacologic pain management interventions. Pharmacological interventions can be opioid or non-opioids. Opioids are centrally performing and systemic in nature whereas non-opioids are also centrally acting but have a peripheral mode of action, and include codeine, metamizol, paracetamol and non-steroidal anti-inflammatory drug (NSAIDS) (Mukherji Rudra 2006, p. 356).Another problem cited by the Joanna Briggs Institute (2004) is that of inadequate pain management techniques and/or follow-through by the patient place additional burdens on family caretakers and the alliance at large. For example, Girgis and Sanders (2004, p. 66) tell us that parents generally underestimate and under treat pain this can be extrapolated to caregivers in the adult community as well. Home caregivers failing to recognize and/or intervene in pain management is often problematic and it is the responsibility of the nurse to assure that proper discharge information is adequately communicated to the patient and/or caregiver/escort, including proper pain management techniques and interventions. To assure there is no confusion, these should be clearly documented and reviewed with the patient and caregiver verbally.ReferencesBeauregard, L., Pomp, A. Choiniere, M., 1998. Severity and impact of pain after day surgery. Canadian Journal of Anesthesia, 45 (4), pp. 304-311.Fisher, A. McMillan, R., 2004. Integrated care pathways for day surgery patients. British Association of twenty-four hour period Surgery Online. obtainable from http//www.bads.co.uk/pdf%20files/IntegratedCarePathways.pdf cited March 17, 2007.Girgis, M. Sanders, D. 2004. Are we giving our children the right dose? The Journal of One- sidereal day Surgery, 14 (3), pp. 65-68.Joanna Briggs Institute, 2004. Management of the day surgery patient Online. Joanna Briggs In stitute Best Practices. operable from http//www.adsna.info/attachments/BPISSup.2004.pdf cited March 17, 2007.Lipp, A. Yap, H, 2005. Is our pain relief protocol effective? The Journal of One-Day Surgery, 15 (3), pp. 64-66.Mukherji, S. Rudra, A., 2006. Postoperative pain relief for ambulatory surgery. Indian Journal of Anaesthesia, 50 (5), pp. 355-362.National Health Services, n.d.a. Day surgery pre-assessment A brief guide Online. Available from www.wise.nhs.uk/surgery/NationalGoodPractice/downloads/14/14d4.doc cited March 17, 2007.National Health Services, n.d.b. Day surgery A good practice guide Online. Available from http//www.wise.nhs.uk/sites/crosscutting/access/Access%20Document%20Library/1/Day%20Surgery/Day%20Surgery%20Guide.pdf cited March 17, 2007Royal College of Nursing, 2004. Day surgery information Selection criteria and suitable procedures Online. Available from http//rcn.org.uk/publications/pdf/daysurgery_selection.pdf cited March 17, 2007.Society of vital Care Medi cine, 2005. Tools for effective communication Online. Society of Critical Care Medicine. Available from http//www.sccm.org/SCCM/Publications/Critical+Communications/Archive/February+2005/communicationsfeb05.htm cited March 17, 2007.Vazirani, S., Hays, R. D., Shapiro, M. F. Cowan, M., 2005. Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. American Journal of Critical Care, 14 (1), pp. 71 77.1Footnotes1 According to the National Health Service (n.d.b), the phrase refers to a patient who is independent, active and compos mentis.