Special Considerations in the Perioperative Environment for Registered Nurses

OR Nursing Assessment

The OR nurse should communicate with the Emergency Department to obtain as much information as possible regarding the injury. Valuable information includes:

  1. Mechanism of Injury (MOI)
  2. SAMPLE — which stands for Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events or Environment leading to the injury
  3. Condition upon arrival
  4. Vital signs, core temperature
  5. Availability of blood and/or products
  6. Input and output
  7. Lab and other diagnostic tests
  8. Spine clearance
  9. Other information such as family presence

(Gawronski, 2019)

With trauma surgery, every minute counts. Some patients may bypass the emergency department or stay just long enough for a quick assessment before coming straight to the OR. In some cases, patients are stabilized in the emergency department before being brought to the OR. In either case, it can be terribly busy and hectic when the patient arrives at the OR. Despite this, it is important for perioperative nurses to consider the essential assessment requirements for providing safe care. They must always receive a report from the emergency team and do a quick assessment of the patient in the preoperative holding area. If the patient’s status is unstable, this may happen as they are being brought directly into the OR.

Airway, Breathing Circulation

During the preoperative assessment, the OR nurse can assess the patient’s airway, breathing and circulation for the following:

  • Status
  • Patterns
  • Condition

(Gawronski, 2019)

Psychological Status Assessment

The OR nurse may assess that support is needed for the conscious patient (and family) who are exhibiting fear and anxiety.

Psychological Status and Supporting the Family

In trauma situations, the family is usually quite distraught. When possible, assign a staff member to bring the family to the surgical waiting area. Check if other family members have injuries themselves which need to be assessed. Ask if they have been able to eat, call their loved ones, speak with spiritual support people. If possible, you might want to page the chaplain, or a social worker. This can be difficult if you work at a smaller facility or if all staff members are supporting the patient.

Make these decisions when you are getting your report from the emergency department. If you do not have the available staffing, ask that they send someone with the family members.

C:\Users\RMurphy\AppData\Local\Microsoft\Windows\INetCache\Content.Word\iStock-1200905538.jpg
Psychological Status and Supporting the Conscious Patient

Despite the level of urgency, if the patient is awake and alert, it is important that the perioperative nurse provides support and reassurance in the same manner as they would for an elective surgical case. This can be done by:

  1. Trying to alleviate the patient’s and family’s fears and anxiety.
  2. Reassuring the patient and family through empathic verbal and non-verbal communication.
  3. Communicating and explaining the interventions prior to the anaesthesia induction.
  4. Using an empathetic approach which could include holding the patient’s hand, speaking softly, and providing a gentle touch.
  5. Introducing the patient to the perioperative environment as they are transferred to the OR bed, see the bright lights, etc.
  6. Describing what to expect postoperatively including the potential presence of wound drains, chest tubes, and other equipment.

(Gawronski, 2019)

Consent

(ORNAC, 2021)