Steps
Step 1
Surgical Case Selection and Perioperative Nursing Framework Design
The core task of this step is to select a typical surgical case and design a perioperative nursing framework covering preoperative, intraoperative, and postoperative phases. The core of surgical nursing is perioperative care.
• Select typical surgical case: choose from general surgery (cholecystectomy, appendectomy, gastrectomy, colorectal surgery), orthopedics (fracture fixation, joint replacement), urology, thoracic surgery; select an elective surgery case; obtain complete history, physical exam, laboratory tests, imaging, and surgical plan
• Design perioperative nursing framework: design nursing content for preoperative (admission to surgery), intraoperative (OR entry to exit), postoperative (return to ward to discharge) phases; each phase includes assessment, diagnoses, goals, interventions, evaluation; emphasize safety management and complication prevention
• Determine assessment tools and risk evaluation: prepare perioperative-specific tools: ASA anesthesia risk classification, POSSUM surgical risk score, nutritional risk screening (NRS 2002), Braden pressure ulcer risk, fall risk, DVT risk (Caprini score), pain assessment (NRS/VAS)
Deliverable: Case summary, perioperative nursing framework diagram, assessment tool list, risk assessment plan | Quality standard: Typical and representative case, systematic and comprehensive framework covering entire perioperative period, professional risk assessment tool selection
Step 2
Preoperative Nursing Assessment and Preparation
The core task of this step is to comprehensively assess the patient's surgical tolerance and complete adequate preoperative preparation, ensuring the patient is in optimal condition for surgery.
• Comprehensive preoperative assessment: systematically evaluate patient's health history (present illness, past history, surgical history, allergies, medication history, family history), physical condition (vital signs, nutritional status, system function), psychological status (anxiety level, knowledge and expectations of surgery), social support; conduct surgical risk assessment (ASA classification, cardiac function, pulmonary function); identify high-risk factors
• Preoperative physical preparation: implement preoperative preparation measures: respiratory preparation (smoking cessation, deep breathing exercises, effective coughing training, nebulization), gastrointestinal preparation (NPO 8-12hrs for food, 4hrs for water, cleansing enema or oral laxative, NG tube placement), skin preparation (surgical site skin cleansing, shaving/depilation, skin disinfection range preparation), elimination preparation, blood cross-matching, allergy testing, preoperative sleep care
• Preoperative health education and psychological care: introduce surgery-related knowledge to patient and family (surgical approach, anesthesia, operative process, ICU environment); provide preoperative training (bedside toileting, turning, breathing exercises, postoperative mobility methods); explain possible postoperative discomforts and coping methods (pain, nausea/vomiting, abdominal distension); provide psychological counseling to reduce anxiety/fear; assist with informed consent process
Deliverable: Preoperative nursing assessment form, risk assessment record, preoperative preparation checklist, health education record, psychological care record | Quality standard: Comprehensive and in-depth preoperative assessment with accurate risk identification, standardized and thorough preoperative preparation, effective health education, stable patient psychological state
Step 3
Intraoperative Nursing Collaboration and Surgical Safety Management
The core task of this step is to analyze operating room nursing work, including patient transport, surgical positioning, instrument preparation, aseptic technique implementation, surgical collaboration, and surgical safety management.
• Surgical patient handover and positioning: analyze preoperative visit and patient transport process (OR nurse pickup from ward, identity verification, preoperative medication administration, safe transport); design surgical positioning plan (supine, lateral, prone, lithotomy); explain positioning key points (maintaining respiratory/circulatory function, avoiding neurovascular compression, skin/eye protection, surgical field exposure) and precautions
• Surgical collaboration and aseptic technique: analyze role division between scrub nurse and circulating nurse; design surgical supply list (instruments, dressings, disposable items, special supplies); explain aseptic technique key points (surgical hand scrub, gowning and gloving, instrument table management, maintaining sterile field); establish instrument count protocol (four counts: before surgery, before closing cavity, after closing cavity, after surgery)
• Surgical safety management: design surgical safety verification process (WHO Surgical Safety Checklist: three verifications: before anesthesia induction, before skin incision, before patient leaves OR); includes patient identity confirmation, surgical site confirmation, procedure confirmation, anesthesia safety check, item count, medication safety, transfusion safety, specimen management; analyze common causes of surgical errors and preventive measures
Deliverable: Surgical positioning diagram, OR nurse role division table, surgical safety checklist, aseptic technique standard, surgical item count protocol | Quality standard: Clear surgical collaboration workflow, strict aseptic technique requirements, specific safety management measures demonstrating patient safety goals
Step 4
Postoperative Nursing and Complication Observation
The core task of this step is to develop a postoperative care plan, implement postoperative monitoring, and observe and prevent postoperative complications. Postoperative care is the key phase of perioperative nursing.
• Postoperative monitoring and assessment: develop postoperative monitoring plan; assess vital signs immediately upon return to ward (every 15-30 min until stable, then gradually extend interval), consciousness, wound dressing (bleeding/drainage), various drains (drainage color/character/amount), pain level, peripheral circulation; assess anesthesia recovery (e.g., Aldrete score); record intake/output; monitor laboratory tests (CBC, electrolytes, blood gas)
• Routine postoperative care: implement basic and specialty postoperative care: pain management (PCA pump use, analgesics, non-pharmacological methods), wound care (healing observation, dressing changes, suture removal timing), drain care (NG tube, urinary catheter, drains: fixation, patency, observation, removal criteria), dietary care (NPO → liquid → semi-liquid → regular diet transition), mobility guidance (early ambulation plan and instruction), psychological care
• Complication observation and prevention: systematically observe and prevent common postoperative complications: postoperative hemorrhage (wound, GI, intra-abdominal bleeding observation and management), surgical site infection (redness, swelling, heat, pain, purulent discharge), pulmonary infection (hypostatic pneumonia prevention: turning, back tapping, deep breathing, effective coughing), DVT (prevention: early mobilization, compression stockings, anticoagulants), urinary retention, abdominal distension, pressure ulcers; create complication observation checklist and emergency management protocol
Deliverable: Postoperative monitoring record, postoperative care plan, complication observation checklist, drain care record, pain assessment record | Quality standard: Close and detailed postoperative monitoring, standardized and thorough nursing interventions, comprehensive complication prevention with keen observation and timely management
Step 5
Surgical Nursing Case Summary and Rehabilitation Guidance Report Writing
The core task of this step is to write a complete surgical perioperative nursing case report and develop a discharge rehabilitation guidance plan. The ultimate goal of surgical nursing is to promote patient recovery and successful return to family and society.
• Write perioperative nursing case report: following surgical nursing case report standards including case introduction, preoperative assessment and preparation, intraoperative collaboration (OR nursing), postoperative care and complication observation, nursing outcome evaluation, discussion and reflections; focus on perioperative safety management, complication observation and prevention, ERAS concept application
• Develop discharge rehabilitation plan: based on surgery type and recovery status, develop individualized discharge rehabilitation plan including: wound care instruction, activity and rest (gradual increase in activity, time to avoid heavy physical labor), dietary guidance (diet structure, nutritional supplementation, contraindications), medication guidance (drug names, dosage, administration, side effects), follow-up guidance (follow-up time, content, when to seek immediate care), psychological adjustment
• Create surgical health education materials: develop a health education manual or video script for this surgery patient, covering preoperative preparation instructions, early postoperative rehabilitation exercises (breathing exercises, limb function exercises, ambulation guidance), diet and nutrition, complication prevention, home care key points, follow-up process; illustrated and easy to understand for patients and families
Deliverable: Surgical perioperative nursing case report, discharge rehabilitation plan, patient health education manual | Quality standard: Complete and standardized case report demonstrating surgical specialty nursing level, individualized and practical rehabilitation guidance, scientific and understandable health education materials