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The Role of the Nurse and the Preoperative Assessment in Patient Transitions
ANN MALLEY, PhD, APRN-NP; CAROLE KENNER, PhD, RN, FAAN; TIFFANY KIM, PhD, RN, WHCNP-BC; BARBARA BLAKENEY, MS, RN, FNAP
ABSTRACT
Transitions in care in the perioperative environment are numerous and should be considered high-risk endeavors. The preoperative area is the rst transition in care for a surgical patient and should be considered a critical dimension of care transition. The purposes of this study were to identify nursings contributions to transitions in care in the perioperative environment and to identify the role of the preoperative assessment in this transition. Qualitative descriptive design was used. Focus groups were conducted with 24 nurses in a 975-bed medical center. The themes that arose in the focus groups were: (1) understanding patient vulnerabilities, (2) multidimensional communication, (3) managing patients expectations, and (4) nursings role in compensating for gaps. We conclude that the nurses role in the preoperative assessment during the transition of preoperative care is that of advocate who identies the patients needs and risk factors that may be affected by the surgical experience. This study suggests that the nursing preoperative assessment can be useful in identifying and dening patients risk factors not just for surgery, but for the entire perioperative care trajectory. AORN J 102 (August 2015) 181.e1181.e9. AORN, Inc, 2015. http://dx.doi.org/10.1016/j.aorn.2015.06.004
Key words: transitions, multidimensional communication, transfer of care, preoperative assessment.
Historically, the goal of preoperative assessment has been to determine patient factors that signicantly increase the risk for perioperative complications.1 Overall, the perioperative complication rate has declined during the past 30 years because of improved anesthetic and surgical techniques.2 However, surgical complications are common and often preventable.3 Analyzing surgical complication data is challenging because of inconsistencies in classifying and reporting events.4 A
recent study by Haynes et al3 demonstrated that the risk of perioperative death from noncardiac surgery was 1.5%, but declined to 0.8% after the use of a surgical safety checklist.
The complexity of the perioperative environment is growing because of an increased use of technology in the setting of institutional production pressures.5 The perioperative environment is information intensive and relying heavily on how well information ows between phases, locations and providers.5(p169) Wide variation exists in the type of
information that is lost in...