CHAPTER 6. Practice Settings, Policies, and Procedures
Sara N. Waldron
OBJECTIVES
At the conclusion of this chapter, the reader will be able to:
1. Define the scope of practice for perianesthesia nursing.
2. Describe the preanesthesia phase of care.
3. Explain the three phases of postanesthesia care.
4. List three inpatient and three outpatient settings where perianesthesia nursing care is delivered.
5. Differentiate between a policy and a procedure.
6. Describe how a procedure is used to implement a policy.
7. Name three agencies or organizations that influence perianesthesia policies and procedures.
8. Identify policies and procedures that define practice in perianesthesia nursing settings.
I. SCOPE OF PRACTICE
A. Perianesthesia scope of nursing practice involves:
1. Assessment and intervention for, and diagnosis and evaluation of physical or psychosocial problems or risks for problems that may result from the administration of sedation/analgesia or anesthetic agents and techniques
2. Care of the patient and family/significant other along the perianesthesia continuum
a. Physical
b. Psychological
c. Educational
d. Cultural
e. Spiritual
B. Perianesthesia nursing practice is based on knowledge of:
1. Physiological and psychological responses
2. Vulnerability of patients subjected to:
a. Sedation/analgesia
b. Anesthetic agents and techniques
c. Specific surgical or procedural interventions
3. Principles of age-specific medical-surgical nursing and critical care nursing
4. Evidence-based practice
C. Perianesthesia nursing roles encompass:
1. Clinical practice
2. Education
3. Research
4. Management
5. Administration
6. Consultation
7. Advocacy
D. Perianesthesia nursing practice occurs in, but may not be limited to:
1. Hospital settings (inpatients and outpatients)
a. Preadmission assessment/testing unit
b. Preoperative/preprocedural holding area
c. Post anesthesia care unit
d. Same-day surgery units
e. Extended observation
f. Labor and delivery
g. Emergency department
h. Special procedure areas
(1) Interventional radiology
(2) Endoscopy
(3) Cardiac catheterization lab
(4) Electroconvulsive therapy (ECT)
(5) Pain management clinic
2. Outpatient settings
a. Ambulatory surgery unit
(1) Hospital based
(2) Free-standing center
b. Special procedure clinics
(1) Interventional radiology
(2) Endoscopy
(3) Cardiac catheterization
(4) ECT
(5) Pain management clinic
c. Office-based practice
(1) Dental
(2) Dermatology
(3) Ophthalmology
(4) Plastic surgery
E. Perianesthesia nursing during all levels of care includes the patient’s family/significant other and other supports whenever possible.
1. Preanesthesia phase
a. Preadmission: preparation for surgery/procedure
(1) Identify potential and/or actual problems
(a) Interview
(b) Physical assessment
(c) Diagnostic testing
(2) Develop plan of care
(3) Education/teaching
b. Day of surgery/procedure: final preparation for surgery/procedure
(1) Review/confirm collected data
(2) Physical assessment
(3) Implement plan of care
(4) Education/teaching
c. Preanesthesia patients separated from patients undergoing procedure and/or recovering from sedation/anesthesia
2. Postanesthesia
a. Phase I: acute care in the immediate postanesthesia period
(1) Focus on safety and comfort during recovery from:
(a) Sedation/analgesia
(b) Anesthetic agents and techniques
(c) Specific surgical or procedural interventions
(2) Utilize and amend plan of care.
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