AORN JOURNAL FEBRUARY 1988, VOL. 47, NO 2

Opinion

Preoperative assessments: Can we afford to do without them?

preoperative patient assessment benefits the A patient, perioperative nurse, and the unit nurse. It is not a luxury; it is a necessary component of patient care.

For many, surgery represents a physiological and psychological crisis affecting patients and families. Because people respond differently to the anticipation of surgery, either the perioperative nurse or the nurse on the surgical unit should perform a total physical and emotional preop- erative assessment of each patient to learn as much a possible about him or her.

Knowledge about patients and how they view the impending surgery are prerequisites for planning effective nursing care. Most hospitalized patients experience some degree of anxiety, and surgery usually increases this anxiety. The amount of anxiety the patient will experience depends on his or her current illness, past experiences, expectations, and coping mechanisms.

Developing a Viable Assessment Process

ssessment is the first step in the nursing A process, without it planning, intervention, and evaluation are impossible. A nurse-patient interaction that is purposeful and continues through all phases of the nursing process begins with the mutual trust and understanding developed from a perception by the patient that the nurse cares about his or her life. Attitudes and past experiences often affect these personal interactions.

The preoperative assessment process combines the subjective responses of the patient with the objective observations of the nurse. It includes an

analysis of the data, and leads to the formulation of nursing diagnoses. A preoperative assessment provides a baseline of information, allowing nurses to provide individualized care that includes emotional and physiological care throughout the perioperative period. This can be especially important when a postoperative patient returns to the unit after the nursing shift present on admission has gone home. Without a thoroughly documented preoperative assessment, the nurse on the following shift has little to compare the patient’s preoperative and postoperative condition. The advantages of preoperative assessment to the

JoAnn Lierman, RN, Ed.!$ is a surgical instructor at the University of Kansas School of Nursing, Kansas City. She earned her bachelor of science in nursing from Graceland College, Lamoni Iowa; a master of science degree in nursing from the University of Kansas, Lawrence; and an advanced practitioner’s degree in education (EdS) from the University of Mhsouri at Kansas Ci&

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Table 1 Advantages to the Patient

Encourages the continuation of quality nursing care Provides the patient with the opportunity to communicate feelings and concerns during the preoperative period, seek assistance in coping with stress throughout the process, and ask for help Offers the patient an opportunity to learn about the events and procedures to be experienced Helps nurses anticipate intraoperative and postoperative complications and maintain physiological stability

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Table 2 Advantages to the Perioperative Nurse

Facilitates continuity of care Increases awareness of patient problems and possible

Provides a basis for making judgments Facilitates an effective therapeutic nurse-patient relationship Increases patient safety through awareness of problems Effectively meets patient’s emotional needs through an

Completes a composite picture of the patient’s physiological

Improves and individualizes the patient’s intraoperative care Facilitates professional interunit communication Contributes to patient cooperation and involvement Humanizes the nurse-patient relationship Provides information with direct implications for the

complications

awareness of their psychological state

condition

patient’s well-being and safety throughout the surgical experience

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patient are outlined in Table 1. family and community, and life-style. A preoperative assessment can A complete physical assessment of all body

systems is a necessity. The presence of any pathological condition should be noted. Informa- tion obtained also should include the psychological makeup of the patient, coping mechanisms, level of anxiety, fear, self-image, and mental capability. The nurse also needs to assess the patient’s sociocultural background including family, level of education, religious affiliation, position in the

reveal an abnormality or problem that may delay or require cancellation of the surgery. It alerts the nurse to the possibility of postoperative complications. Quality of care can be jeopardized when the nurse makes assumptions without first assessing the patient.

Nurses rely upon one another for information when the patient is transferred from one unit to

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Table 3 Advantages to the Unit Nurse

Provides accurate information needed to formulate a plan of

Allows establishment of realistic patient outcome criteria Anticipates psychological and physiological needs in the postoperative recovery period Facilitates accurate and complete documentation of nursing action, while meeting expected standards of the profession Allows objective evaluation of patient care Provides an opportunity to compare preoperative baseline

Better assists the patient with management of anxiety in the

patient care

data with postoperative course data

preoperative and postoperative periods I

another. Pertinent data collected through a utilization of time. preoperative assessment provides a basis for planning appropriate preoperative and intraoper- ative nursing action, as well as postoperative care.

Perioperative nurses work toward safe patient care with a favorable surgical outcome. A thorough evaluation by the unit nurse can have advantages for the perioperative nurse (Table 2).

Every patient deserves the best possible care. The nursing process provides a structure that ensures accountability and avoids fragmentation of care. The unit nurse can enhance quality care through the use of preoperative assessments (Table 3).

Enhancing the Quality of Care

muse communication is vital for quality B patient care, patient assessment could be enhanced through joint professional collaboration in the development of assessment forms that could be universally beneficial to all nurses involved in patient care. With the growing use of computers in the nursing field, a patient assesssment could be completed by the unit nurse, entered into a computer, and sent to the OR. This lets the perioperative nurse begin planning care earlier and increase cost effectiveness. Time spent by the perioperative nurse waiting for the patient and cart to arrive could be eliminated, allowing better

Education courses in patient assessment are always beneficial in establishing, building, or reviewing skills. In-service education programs allow nurses from all patient care areas to work and learn together, thus developing rapport and colleague confidence.

The essence of quality care lies in the nurse’s ability to comprehend nursing problems, provide individualized interventions, and meet the patient’s physiological and psychological needs. A complete preoperative assessment is the beginning step in meeting the patient’s needs and providing quality care.

JOANN LIERMAN, RN

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