Preoperative Procedures In Nursing
Preoperative Procedures In Nursing
This involves the care that is given to a patient before, during and after a surgical process. The procedures aim to provide better conditions for surgical patients before they are operated on, during the operation and after the operation. There are some of the preoperative procedures which are conducted in the surgical floor that are questionable. In fact one is left to wonder if some of the procedures have a basis in research. This paper will therefore look at the basis of one of some of these procedures, suggestions on changes that can be made to them and any barriers that might arise when it comes to the implementation of the revised clinical practice guidelines (Rosdahl,., & Kowalski, 2012).
Among the questionable preoperative procedures is the shaving of areas where incisions of surgery have to be made. This routine procedure is used worldwide by many surgeons before an operation. This is can be done immediately before the surgery or even a day before the operation. The hair removal procedure can be done in various ways including the use of clippers, razor blades for shaving, electric shavers and hair-dissolving creams to remove hairs that might be present on the area where an incision has to be made. Before shaving is done there are several pre-surgical skin preparations that are done this include full body wash with povidone-iodine or chlorhexidine.
The practice is acceptable by surgeons worldwide and they consider it mandatory. The hospital management and doctors also fall in this category. Therefore the entire management of the hospital is the ones that determine the basis for the procedure since all their colleagues in other hospital worldwide are using it.
It is believed that shaving lower the risk of infection of the surgical site which is not really the case. Shaving is also intended to remove anything that might obstruct a surgeon from viewing the area of incision. This will therefore enable the surgeons to easily access the incision site or area. Some surgeons believe that shaving is a way of removing bacteria that are found on the surgical area which could otherwise cause contamination of the surgical area. Another rationale behind shaving of the site of surgery sis the belief that the procedure leads to reduced wound infections, an increase in exposure of incision site at the same time facilitate the dressing and the closing process. There are other cases that are seen to necessitate the removal of hairs such as when there is need for the application of adhesive lads on the skin of the patient before surgery is done. If hair is present then it means that there can be no way that the leads can reach the incision area.
Research has shown that the shaving of skin before surgery raises the risk of infection of the area after the surgery. This is because intensive antibacterial handling that is done before the shaving of the area can cause the disruption of the healthy skin flora at the same time enabling the area to be colonized by pathogenic agents (Celik, & Kara, 2007). At the same time altering of skin flora due to shaving is associated with increased growth of bacteria and eventually leads to infection. The surgical site infections increase complications in patients and they account for most of the infections associated with health-care and eventual death of patients. This therefore shows that this procedure is quite inappropriate. This implies that preoperational shaving procedures should go through some transformations regarding the methods that are utilized in the process of removing hair.
Threat to infection is seen to potentially increase as the length of time between shaving is done and the actual surgery. Shaving that is done in the operating room inflicts micro trauma on a patient’s skin at the site of incision as well as damaging hair follicles that are located on the sites before surgery hence the area becomes susceptible to being colonized by organisms that are infectious. There is a clear indication of an indirect connection between surgical infections and removal of hair before surgery. Therefore it is implied that failure remove hair or shave is away of reducing infections. It is also indicated that incision sites that are hairy do not increase surgical infections. Due to the clinical implications of shaving it is suggested that it is not necessary to remove hair on surgical sites not unless it will interfere directly with the operation.
Because of several implications that come in as a result of shaving on the surgical sites, there are some of the suggested changes that should be taken into consideration to stop those implications. For instance, the nurses should use depilatory creams instead of shaving the patient when there happens to be a necessity of performing the preoperational hair removal. This is because; there are small abrasions as well as cuts associated with shaving which can quickly results to the emergency of the infections. This on the other hand indicates that, the preoperative procedures such as shaving should never be viewed as being highly appropriate and acceptable. However, the justification regarding the procedure may possibly be based on the reasons of humanitarians, for example, in cases where the presence of the hair tends to make it difficult for the surgeons to clearly see the site of incision. The other scenario that may necessitate the removal of hair from the patients by the surgeons is when there may be need of applying the adhesive leads to the skin prior to surgery. Despite of all the suggestions collected from various literature sources, there is still ongoing debates where most people are arguing out on whether it is necessary for the intended surgical sites to be shaved or not (Perry, Potter, & Elkin,2012).
The other significant suggested change is the need to change the staffs’ perception by telling them that, shaving is mainly significant in reducing the risks of the surgical site infections. According to the research conducted in hospital personnel regarding the preoperative shaving procedures, the information collected showed that the main reasons behind shaving is in the fact that the majority of the surgeons believes the procedure may help in reducing the rate of infections as well as enables the ease of access to the point of incision. The data gathered also indicated that the nurses carry out the procedure before or a day before the surgery. However the preferred time is immediately before the surgery is done so as to reduce risks of bacterial infections.
Nurses should use clippers instead of razors when shaving the surgical sites. In this case, they should use hair dissolving creams that is associated with few cases of breaches in skin. The other recommended practice is by carrying out preoperational shaving close to the surgery time that is at most 3 hours before surgery procedure. The suggested change is due to the findings from the data gathered which indicated that, the adverse effects on the wound infection is as a result of shaving. Conversely, hair removal prior to surgery helps in reducing the rate of infection.
Various barriers may arise when implementing the change. The key stakeholders to be included in for decision making in order to transform the preoperative procedure may include the patients, nurses, the health experts and the clinicians. It will be therefore difficult to implement the change unless one gets to know what the stakeholders will say about the changes suggested. Patients on the other hand will be required to air out their views so as to generate new ideas on the methods to be employed during the surgical site hair removal process. The health experts will also help in creating awareness as well as creating the preoperational nurses concerning the merits and the demerits of using surgical site shaving (Altman, 2004).
It is therefore necessary for the one implementing the changes to clearly educate those who are involved in carrying the practices such as the surgeons by communicating effectively on the reasons behind the implementation of the change. The other barrier to implementing change can be as a result of communication breakdown in the organization. For instance communication breakdown can result to information and data misinterpretation. The other barrier may be as a result of lack of support from the leadership team. In most cases, there are people who may be willing to accept change while others will never accept to implement the change. In this case, nurses may be willing to implement the change however they may not get enough support from the senior staffs. To overcome all these problems to change the institution, training as well as effective communication should be put as the main strategies for implementations.
Altman, G. (2004). Delmar’s fundamental & advanced nursing skills (2nd ed.). New York: Thomson/Delmar Learning.
Celik,S.E & Kara,A.(2007). Does Shaving the Incision Site Increase the Infection Rate After Spinal Surgery? Retrieved March 20,203 from http://www.medscape.com/viewarticle/559891_4
Garber, J. S., Gross, M., & Slonim, A. D. (2010). Avoiding common nursing errors. London: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Perry, A. G., Potter, P. A., & Elkin, M. K. (2012). Nursing interventions & clinical skills (5th ed.). New York: Mosby.
Rosdahl, C. B., & Kowalski, M. T. (2012). Textbook of basic nursing (10th ed.). London: Wolters Kluwer Health/Lippincott Williams & Wilkins.