1 Precepting Journal Jaxserimar Rosa Quinones Halifax Health/Operating Room NURS 2940: Nursing Process V School of Nursing, Daytona State College 2 Precepting Journal This is my first time precepting at Halifax Health, previously all my clinicals have been at an Advent facility. I was looking forward to experiencing a whole new environment than what I was used to. I am looking forward to learning everything that the operating room has to offer. Week 1 Description The operating room was nothing like I expected. This side of nursing is nothing like we have learned in school, so it was very refreshing to learn new things like the different machines, instruments, and type of surgeries that are performed. Feelings I was very nervous on my first day on the unit since it was something that I have never experienced before. I also felt very lost due to basically not knowing what the different instruments, and machines the scrub techs and nurses were talking about. It was also very nerve recking not knowing what was sterile, and what wasn’t since I almost broke sterile field a couple of times. Evaluation Even though everything felt very foreign to me I tried my best to jump in and help everybody with everything I could. I helped position the patient, give report to the PACU nurses, and get all the information needed from the patient since that is something I know how to do very well. I also, took home a paper that talked about all the different types of instruments the scrub techs, and surgeons use during surgery. Analysis 3 My nurse was very helpful with taking the time to explain what everything was, but it was still a little complicated to remember everything when I have never seen it before. By not knowing what was considered sterile and what wasn’t I almost broke sterile field a couple of times making the scrub tech a little annoyed. I feel like the operating room I experienced was nothing like they portrayed on tv shows or movies. Conclusion I wish I could have taken the time to thoroughly research what was expected of the operating room. It was a great first week experience and I will be trying a lot harder to learn everything that it is necessary. Action plan I will make sure I take the time to learn as much as the instruments and machines that are used in the OR. I will also make sure to research how to always maintain sterile field. I will also take the time to research what are some of the surgeries that are performed routinely like the bariatric surgery. Week 2 Description This week I experienced a very shocking situation in the Operating Room. My nurse, and other team members oversaw the positioning of a patient on the operating table, the surgeon verified the positioning and approved of it. Sadly, while in the middle of the operation the patient had a neurologic reaction and fell off the bed. Thankfully, the patient ended up being okay after the surgery. Feelings 4 I was very shocked this happened. When I saw the patient on the floor in the operating room, I felt sick to the pit of my stomach. I was just thinking how the patient’s site was open, and I was very scared he might have caused more damage to himself Evaluation Everybody was shocked but we were all able to react accordingly. We covered the patient’s site with a dressing and raised him on to the stretcher to first make sure he was stable. After providing the care that was needed the surgeon continued with the patient’s surgery. Analysis When it comes to securing and positioning a patient, I believe there should be a more comprehensive check. Because the first assist, who generally positions the patient, was not available at the time of preparation, everything was communicated over the phone, and the team members were unsure if they were doing everything correctly. The surgeon also made things a bit more complicated by prepping more skin than was necessary, resulting in the inability to secure a normal area of the body that is secured in these types of surgeries. Conclusion In conclusion, I learned that positioning is HIGHLY important to be able to maintain our patient safe during surgeries. Always make sure to take the time to check that everything is correctly done, correct equipment is being used, and everything is secured. Action plan I will make sure I learn all the different types of positioning for all the different types of surgeries that are performed. I will also look into more information on the equipment that is used, like the specific table, pillows, settings, etc. Week 3 5 Description This week I was finally able to go into the patient’s room and ask all the questions necessary to the patient, check all the consents forms, do a time-out, and give report to the PACU nurse after the surgeries were done. I was also successful in maintaining sterility when opening certain instruments that were needed during the surgery. Feelings I felt very excited and nervous to call a time-out in front of all the operating room team members. I also felt a bit scared to give report back to the PACU nurse because I consider giving report not my strong suit, but I was able to perform successfully, so I was very relieved at the end. Evaluation My nurse expressed how she was proud of me because I was able to do everything successfully. So, I think everything went well. I did feel awkward having to call out a time-out in front of a group of people but at the end I realized it was nothing to be nervous or feel awkward about. Analysis What help me in this situation was having practice on giving reports thanks to Professor Boone. Due to having to give reports on two patients every week during my clinicals helped me prioritize pieces of information. Conclusion In conclusion, I would like to keep performing all these tasks during my preceptorship so I can get more comfortable with speaking with patients, surgeons, nurses, and all the other 6 operating room staff. I will always make sure to try and take the initiative to do things I’ve never done before. Action Plan I will make sure to keep giving reports, speaking to patients, and doing anything that is required by an operating nurse so I can get a lot more comfortable in the future. Practice makes perfect! Summary I was able to complete all of the needed clinical objectives during my preceptorship. I was able to utilize aseptic technique, sterilization, and disinfection principles by executing activities such as opening packages while keeping them sterile, waiting after the surgery to disinfect alongside the OR tech, and performing other skills. In addition, I displayed therapeutic communication with the surgical team and the patient. When patients were in same-day surgery, I was able to complete numerous history and physical examinations, and I double-checked that both the anesthesiologist and the surgeon had signed the consents. Before beginning surgery, I would give a "time-out," which entails going over all pertinent information from the patient and ensuring that the correct procedure was being conducted. I always delivered a report to the PACU nurse at the end of the surgery regarding what happened in the operating room, as well as all of the important information about the patient. 7 References All handoffs are not the same: What perioperative handoffs do we participate in and how are they different? Anesthesia Patient Safety Foundation. (2021, October 1). Retrieved April 19, 2022, from https://www.apsf.org/article/all-handoffs-are-not-the-same-whatperioperative-handoffs-do-we-participate-in-and-how-are-they-different/ Brooks, A. (2020, May 4). Dissecting the critical role of an operating room nurse. Rasmussen University. Retrieved April 19, 2022, from https://www.rasmussen.edu/degrees/nursing/blog/role-of-operating-room-nurse/ JY;, T. R. J. A. M. M. K. (2020). Preventing falls in the operating room: A technique tip for safely tilting the operating table. Foot & ankle specialist. Retrieved April 19, 2022, from https://pubmed.ncbi.nlm.nih.gov/23863398/#:~:text=Technique%3A%20When%20tilting %20the%20operating,or%20access%20into%20the%20joint.
