An evolution of day surgery nursing : an action research process to improve the principles of care for people having complex day surgery

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NO FULL TEXT AVAILABLE. Access is restricted indefinitely. ----- This research aimed to develop a model of care that would offer patients undergoing complex procedures a day surgery option that was effective, safe and patient centred. The development of this research was based on critical theory especially the tenets of honest and open communication and the involvement and consensus between all stakeholders charged with the care of the patient. Initially day surgery nurses at the studied hospital were found to be task orientated with limited accountability focussing on the organisation's demand to "process" patients through the hospital as efficiently as possible. Patient management through the day surgery journey was found to be absent of patient centredness and compromised patient safety and effectiveness. Through communicative action and the process of action research nurses changed the way in which they thought and went about their work for patients undergoing complex day surgery. The many changes made to the surgical journey of patients' undergoing complex surgery as day procedure were highly successful. These changes included the introduction of nurse assessment of patients at the pre-admission clinic (PAC), an emphasis on patient and carer education at all stages of journey and the improved coordination of patient management. Previously there had been no opportunity for adult patients to undergo complex procedures as day surgery. In 2001-02, 55 patients underwent one of the two complex day surgery procedures offered. Other than one readmission within 24 hours of a patient who required pain relief there were no further complications or incidents in the patient group. Suitable patients are now given the option for day surgery of some complex surgical procedures. The action research process has also been successful in relation to the empowerment of clinical nurses through collaborative decision making using the best available evidence. The success of the model suggests that it is transportable across a number of specialties and procedures. The author contributes to the development of theory concerning change in the clinical settings. The support of senior management is crucial to allowing nurses to embark on a journey of acquiring knowledge and subsequent decision making regarding the management of patients through their surgical trajectory. The facilitation of a process, such as this, must be undertaken by a person who has leadership skills and who places an emphasis on the empowerment of nurses. There must also be awareness that sustainable change requires sufficient time. The author acknowledges the tension between the principles of care, which nurses value, and the demands placed on nurses' work by hospitals.
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