Identifying Interventions per Nursing Diagnoses for Certified Perioperative Nurse (CNOR)

Identifying Interventions per Nursing Diagnoses

Guidelines:

• Planning
  • After collecting/interpreting patient data, identifying appropriate nursing diagnoses, and establishing desired outcomes
  • Requires:
    • Nursing knowledge
    • Patient information
    • Intended procedure information
  • Involves:
    • Planning patient care
    • Preparing the surgical environment
    • Modifying routine based on unique patient information
• Implementation
  • Performing planned nursing interventions
  • Requires:
    • Responding with critical thinking and orderly action to changes
      • Surgical procedure
      • Patient’s condition
      • Emergencies
    • Continued assessment
      • Appropriateness of interventions
      • Alteration of interventions to achieve desired outcomes
  • Involves:
    • Standards of nursing care
    • Recommendations for practice
    • Best practices

Considerations:

• Top Perioperative Patient Safety Issues:
  • Preventing wrong site/procedure/patient surgery
  • Preventing retained surgical items
  • Preventing medication errors
  • Preventing failures in instrument reprocessing
  • Preventing pressure injuries
  • Preventing specimen management errors
  • Preventing surgical fires
  • Preventing perioperative hypothermia
  • Preventing burns from energy devices
  • Responding to difficult intubation/airway emergencies

Nurse’s role:

• Interventions are the “work of nursing”
• Use your foundational knowledge, adapt to changes, prioritize actions
• Use your knowledge of the sequence of steps and surgeons’ preference cards, nursing care guides, and other resources to prepare for the patient and surgical team.
• So what is part of planning?
  • Equipment check
  • Supplies
  • Positioning Devices
  • Instrument/suture/accessory items
  • Room Setup
• What are the interventions?
  • Applying grounding pad
  • Delivering ordered medications to the backtable
  • Applying padding to bony prominences
  • Completing the count process
  • Etc.

Pitfalls:

• Delegation:
  • Perioperative nurse may delegate certain nursing activities to unlicensed assistive personnel
  • Know your state board of nursing’s definition for RN scope of practice!
  • Accountability remains with the RN after delegation
  • Supervision of care cannot be delegated
• State board of nursing > Institutional policy
• CNOR prep: Know where to go for information

Examples:

• State board of nursing
  • Nursing Practice/Scope
• Hospital/Organization
  • Policies
  • Procedures
• AORN Guidelines for Perioperative Practice
  • Best practice recommendations
• Major Government Agencies
  • Patient safety info for facilities and individual professionals
    • Think CDC, CMS, FDA, NIH, etc.
    • Federal and state regulations including through financial incentives
• The Joint Commission
  • National patient safety goals
    • Standardized methods of patient identification
    • Universal protocol for preventing wrong site/procedure/patient surgery

Linchpins (Key Points):

• Interventions = the “work of nursing”
• Interventions are driven by the nursing diagnosis and identified outcomes
• Interventions are planned
• Interventions may change