How does a perioperative nurse apply Nursing Standard 7 into practice?

Applying Nursing Standard 7 in Perioperative Practice

Perioperative nurses should implement Nursing Standard 7 by functioning as specialized care coordinators who provide comprehensive patient-centered care through structured assessment, individualized planning, and evidence-based interventions that prioritize patient safety, dignity, and optimal outcomes throughout the surgical continuum.

Understanding Standard 7 in the Perioperative Context

Standard 7 focuses on the nurse's role in coordinating care and implementing evidence-based interventions within a multidisciplinary framework. In perioperative settings, this translates to:

• Functioning as a specialized coordinator of patient care who meets individual needs of patients and families while preparing them for scheduled procedures and postoperative recovery 1
• Implementing protocol-driven integrated pathways that are adapted to each patient's unique circumstances 2
• Participating in multidisciplinary care teams that have been shown to improve outcomes for surgical patients, especially elderly and high-risk populations 2

Preoperative Phase Implementation

• Conduct early assessment and optimization of the patient's condition, tailoring the approach based on available time before surgery (longer for elective procedures, shorter for emergency cases) 2
• Provide patient education in oral, written, and/or pictorial formats to both the patient and a relative/caregiver 2
• Screen patients for modifiable risk factors including smoking, alcohol use, undiagnosed hypertension, diabetes, anemia, and nutritional status 2
• Implement multimodal intervention strategies to prevent postoperative delirium, especially in elderly or high-risk patients 2
• Document treatment plans based on discussions between patients and senior clinicians in advance of hospital admission, including proposed management of expected complications 2

Intraoperative Phase Implementation

• Apply the Surgical Safety Checklist to ensure standardized safety protocols 2
• Maintain core temperature at ≥36°C through active warming for operations lasting longer than 30 minutes 2
• Implement opioid-sparing analgesia techniques combined with local and regional blocks when appropriate 2
• Advocate for minimally invasive surgical approaches when resources and expertise are available 2
• Maintain near-zero fluid balance and avoid routine use of nasogastric tubes and drains 2

Postoperative Phase Implementation

• Facilitate early oral feeding (fluids as soon as the patient is lucid, solids after 4 hours) 2
• Promote early mobilization (30 minutes on day of surgery, 6 hours/day thereafter) 2
• Administer multimodal opioid-sparing analgesia using combinations of paracetamol and NSAIDs, with opioids as last resort and in low doses 2
• Remove urinary catheters within 24 hours after surgery for most patients 2
• Monitor key parameters including respiratory and heart rate, blood pressure, oxygen saturation, level of consciousness, and surgical site 2

Strategies to Overcome Implementation Barriers

• Create documentation templates that incorporate the principles of evidence-based perioperative care to facilitate theory-based care planning 3
• Implement educational programs focused on practical applications of nursing theory in perioperative settings 3
• Use a participatory approach involving nurses in adapting guidelines to their specific practice environment 2, 3
• Establish organizational policies that support evidence-based nursing practice in perioperative care 2, 3
• Conduct continuous audit of processes of care, compliance to guidelines, and outcomes 2

Special Considerations for Vulnerable Populations

• For elderly patients, assume they have the mental capacity to make decisions about their treatment unless clearly demonstrated otherwise 2
• Maintain continuity of care through reciprocal information flow between patients, relatives/carers, and primary and secondary care services 2
• Recognize that elderly patients are at higher risk for postoperative delirium and implement preventive measures 2
• Address pain management proactively, especially in cognitively impaired patients who may not effectively communicate pain 2
• Avoid prolonged pre-operative fasting and promote appropriate nutritional support 2

Common Pitfalls and How to Avoid Them

• Failing to recognize cognitive impairment: Use standardized screening tools to identify at-risk patients 2
• Inadequate pain management: Implement multimodal analgesia and regular pain assessments 2
• Poor communication during care transitions: Ensure comprehensive handover between care settings 2
• Inconsistent application of evidence-based practices: Use standardized protocols and checklists 2
• Overlooking the importance of audit: Continuously monitor compliance with guidelines and patient outcomes 2

By systematically implementing these evidence-based approaches, perioperative nurses can effectively apply Standard 7 to improve patient outcomes, enhance safety, and provide high-quality care throughout the surgical journey.