Standards of Nursing Practice: Operating Room Medical-Surgical Nursing Practice Medical-surgicalnursing practice is defined as the nursing care of adults who have a known or predicted physiological alteration. In planning nursing interventions, medical-surgical nursing practice must take into account all related social and behavioral problems resulting from or affecting the patient’s response and/or adjustment to the physiological alteration. The practice of medicalsurgical nursing is carried out in those settings which deliver primary, acute, and long-term care. The Standards of Medical-Surgical Nursing Practice provide a basic model by which the quality of medical-surgical nursing practice may be measured. They provide a means to determine the quality of nursing care which a person receives, regardless of whether such services are provided solely by a professional nurse or by a professional nurse in conjunction with nonprofessional assistants. Since the professional nurse is primarily accountable and responsible for the nursing process, the standards focus on the process of nursing practice. Although the setting in which care is delivered and the observable outcomes of care are considered, they are not the focus of this group of Standards. The Standards provide a model to guide the development of a reliable means to assess the quality of the nursing process which is provided in any setting for any type of physiologic alteration in adults. In order to implement the nursing process effectively, nurses who are engaged in the practice of medical-surgical nursing should: 1 . base nursing practice on principles and theories of biophysical and behavioral sciences 2. continuously update knowledge and skills, applying new knowledge generated by research, changes in health care delivery systems, and changes in social profiles 3. determine the range of practice by considering the patient’s needs, the nurse’s competence, the setting for care, and the resources available 4. insure patient and family participation in health promotion, maintenance, and restoration Because of the breadth of the scope of practice reflected in the area designated as medical-surgical nursing, it is the intent of the ANA Executive Committee of the Division on Medical-Surgical Nursing Practice to establish standards of practice in areas of specialized nursing practice; for example, cardiovascular nursing and oncological nursing. Such standards will be based upon the ~

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general Standards of Medical-Surgical Nursing Practice, which are stated according to a systematic approach to nursing practice. The specific delineations are not intended to imply that practice consists of a series of discrete steps, taken in strict sequence, beginning with assessment and ending with evaluation, but rather that the processes are used concurrentiy and recurrently. Each standard is followed by assessment factors. These factors are to be used in determining achievement of standards. The assessment factors, as enunciated in Standards of MedicalSurgical Nursing Practice, are broad in scope in order to serve as a basis for further development of specific assessment factors for the many and varied specialty areas within the broad field of medical-surgical nursing. Specialty standards may focus on the setting and specific patient outcomes (goals). A joint committee of the Association of Operating Room Nurses and the American Nurses' Association's Executive Committee of the Division on Medical-Surgical Nursing Practice determined that the nursing care of individuals who are experiencing surgical intervention in the operating room is one such specialized area of nursing practice where further delineation of the specific assessment factors and patient outcomes would provide a means for evaluating the quality of nursing care received by these patients.

Operating Room Nursing Practice These standards relate to the particular nursing practice for individuals who are experiencing surgical intervention in the operating room. In planning nursing interventions, nurses who engage in nursing practice in the operating room must take into account related physiological, social, and behavioral problems resulting from or affecting the individual's response and/or adaptation to the surgical intervention. The practice of nursing in the operating room is carried out in those settings which deliver acute care. The scope of this practice encompasses those nursing activities which assist the individual having surgical intervention. The nursing activities are directed toward providing continuity of care through preoperative assessment and preparation, intraoperative intervention, and postoperative evaluation. These standards have been approved by the Association of Operating Room Nurses' Board of Directors and by the American Nurses' Association's Executive Committee of the Division on Medical-SurgicalNursing Practice. They have been developed as guidelines for operating room nurses to use in establishing standards in their own clinical settings. Standard 1. The collection of data about the health status of the individual is systematic and continuous. The data are recorded, retrievable, and communicated to appropriate persons. Data are obtained by interview, physical examination, review of records and reports and consultation.

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Priority of data collection is determined by the immediate health care problems of the individual.

Assessment factors 1. Health data include, but are not limited to: a. Current medical diagnosis and therapy b. The individual's perceptions and expectations which relate to his present health status c. Previous responses to illness, to hospitalization and surgery d. Environmental, occupational, financial, educational, recreational, and spiritual information as it relates to the individual's habits and social work roles 8. Understanding of the surgical procedure and signed consent f. The psychosocial behavior of the individual as it relates to the surgical experience __ level of anxiety ~-~ patterns of copingfadaptation sexuality ~. threat to body image g. Physical status and physiologic response __ allergic responses __ drug use _ _ level of consciousness physical appearance _ _ skin color, skin temperature, integrity, turgor, presence of rash, abrasions __ body structure and size __ disabilities/impairments __ mobility limitations prosthesis ability to verbalize ~. vital signs results of diagnostic studies CBC blood type and crossmatch urinalysis __ chest x-ray ~. ECG serum chemistries time of last food or fluid intake and voiding 2. Health data is collected by appropriate methods. 3. Health data collection is complete. ~

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Standard II. Nursing diagnosis is derived from health status data. Nursing diagnosis is a concise statement and the product of the assessment phase identifying the individual's presenting problems, strengths and limitations, and methods of adapting to the current situation.

Assessment factors 1 . The nursing diagnosis is based upon identifiable data and is determined by continuous analysis and interpretation of data.

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2. Health status deviations are determined by comparing the previous condition. 3. Nursing diagnosis is consistent with current scientific knowledge.

Standard 111. Goals for nursing care are formulated. A goal is the end state toward which nursing action is directed.

Assessment factors 1. Goals are derived from nursing diagnosis. 2. Goals are stated in terms of observable outcomes. 3. Goals are formulated by the individual, his family, significant others, and health personnel. 4. Goals are congruent with the individual's present and potential physical capabilities and behavioral patterns. 5. Goals are attainable through available human and material resources. 6. Goals are achievable within an identifiable period of time. 7. Goals are assigned appropriate priorities. The goal of operating room nursing for an individual with surgical intervention is promotion, restoration, and maintenance of physiological alterations through application of biophysical sciences, principles of asepsis, and technological knowledge and skills needed to insure a safe, comfortable, and effective environment for the welfare of the individual. The following patient outcomes are specific to individuals requiring operating room nursing care. Identification of observable outcomes depends upon the known health status of the individual. The individual is free from infection The individual's skin integrity is maintained The individual is free of adverse effects from lack of or improper use of safety measures . improper positioning extraneous objects chemical, physical, and electrical hazards .. The individual's fluid and electrolyte balance is maintained The individual's and/or responsible party demonstrates knowledge of the individual's physiological and psychological responses to surgical intervention The individual participates in the rehabilitation process ~

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Standard IV. The plan for nursing care prescribes nursing actions to achieve the goals. The plan for nursing care describes a systematic method to attain the goals. The plan is initiated following nursing diagnosis.

Assessment factors 1. The plan includes setting priorities for appropriate nursing actions. 2. The plan includes a logical sequence of actions to attain the goals. 3. The plan is based on current scientific knowledge.

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4. The plan incorporates available and appropriate human and

material resources. 5. The plan can be implemented. 6. The plan reflects the consideration of the “Patient’s Bill of Rights.” 7. The plan is developed with and communicated to the individual, family, significant others, and health personnel as appropriate. 8. The plan specifies the following: a. what nursing actions are performed b. how the nursing actions are to be done c. when the nursing actions are to be performed d. where the nursing actions are to be performed e. who is to perform the nursing actions. 9. The plan reflects preoperative assessment. 10. The plan includes but is not limited to the following specific nursing activities in the operating room: a. assurance of information and supportive preoperative teaching specifically related to the surgical experience and operating room nursing care b. identification of individual c. verification of surgical site d. verification of operative consent and procedure and reports of essential diagnostic procedure e. assurance of proper positioning and transference of the individual to prevent obstruction to respiratory, circulatory, and neurological functions f. maintenance of asepsis g. assurance of proper grounding of equipment and personnel h. assurance of appropriate equipment and supplies for the individual i. provision for comfort measures and supportive care to the individual j. protection of the individual from hazards of surgery and anesthesia k. assurance of notification of responsible party when operative procedure is completed I. monitoring environmental controls: temperature range humidity range ~electrical safety measures physical safety measures noise control traffic control control of contaminants m. assurance of properly functioning equipment. ~

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Standard V. The plan for nursing care is implemented. The plan must be implemented to achieve the goals.

Assessment factors 1. The nursing action can be documented by written records,

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observation of nursing performance and/or individual’s reports of nursing actions. 2. Nursing actions are consistent with the plans for continuity of nursing care preoperatively, intraoperatively, and postoperatively. 3. The nursing actions are performed with safety, skill, efficiency, and effectiveness. 4. The nursing actions reflect consideration of the individual’s dignity and desires.

Standard VI. The plan for nursing care is evaluated. Individual’s response is compared with observable outcomes which are specified in the goals.

Assessment factors 1. Current data about the individual are recorded and used to measure progress toward goal achievement. 2. The individual, family, significant other, and health personnel contribute to the evaluation of goal achievement. 3. The degree of goal achievement is communicated by the nurse to the individual, family, significant others, and health personnel. Standard VII. Reassessment of the individual, reconsideration of nursing diagnosis, resetting of goals, modification and implementation of the nursing care plan are a continuous process. The steps of the nursing process are taken concurrently and recurrently.

Assessment factors 1. Reassessment is directed by goal achievement and/or new data. 2. The nursing care plan is modified to meet the individual’s changed condition. 3. Current nursing diagnosis, goals, and revised nursing care plan are consistent with evaluation of the individual’s progress. Copyright, American Nurses’ Association 1975. A limited number of booklets, Standards of Nursing Practice: Operating Room, are available at $1 per copy from AORN Headquarters, 10170 E Mississippi Ave, Denver, Colo 80231.

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Standards of nursing practice: operating room.

Standards of Nursing Practice: Operating Room Medical-Surgical Nursing Practice Medical-surgicalnursing practice is defined as the nursing care of adu...
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