Effectiveness of trained nurses in preoperative assessment
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7389.600 (Published 15 March 2003) Cite this as: BMJ 2003;326:600
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I think it is time to stop contrasting nurses practice versus doctors
practice. It is not that helpful to overall patient care and leads to a
debate merely about who does what to whom .
These two letters make very interesting points and I think reflect the
increasing number of papers/features I receive at Nursing Times about who
does what better - which is not really the point in the overall care of
the patient. It may be better for the patient to do elements of their own
assessment and care and then the healthcare team can use that information.
This frees up time for those patients who require more input.
I think nurses should feel confident that as they take on more elements of
the patients care that they do not constantly have to prove that they are
as good as or better than doctors at it.
Nurses and doctors should consider from a holistic view of how
multidisciplinary working improves the care of the patient during their
illness and how it could be made more effective.
Competing interests:
None declared
Competing interests: No competing interests
Pre-operative assessment - a junior doctor's perspective
Editor - I read with great interest, the debate about whether a nurse
or a doctor should be conducting a pre-operative assessment clinic (1, 2).
As found in the study by Kinley et al., it is clear that with adequate
training a nurse should be perfectly capable of doing this exercise (3).
But this statement is a rather simplistic assessment of a very important
aspect of surgical care. Having worked as a junior doctor (Basic Surgical
Trainee) recently, I feel that a nurse led pre-operative assessment
appears to be adequate for minor surgical procedures like hernia repair or
varicose vein surgery. However, extending this facility to encompass all
surgical procedures seems rather absurd.
Pre-operative assessment clinic is the only time when a doctor from
the team gets a chance to comprehensively assess his/her patient’s normal
health, understand the patient’s circumstances, allay any fears, address
relevant issues, and crucially, know about the patient’s past medical
history. Many patients undergoing major surgeries like abdominal aortic
aneurysm repair or abdomino-perineal resection may have a protracted and
complicated post-operative period. In these circumstances, a clear
understanding of the patient’s past medical problems and pre-operative
health status is vital in instituting appropriate management, besides
being helpful when liaising with other specialists (e.g. Intensivist or
Radiologist).
Therefore, pre-operative assessment should not be seen merely as an
exercise to assess the patient’s fitness for surgery, but as an
opportunity for the patient and the doctor to develop a rapport, which is
of paramount importance in the patient’s post-operative recovery and care.
Therefore, though a nurse running a pre-operative assessment clinic suits
the interests of the managers and trusts in terms of achieving waiting
list targets, we need to ensure that patient’s interests and well-being
are never compromised and are placed above any politically driven agenda.
References:
1. Andrew C Skinner. Paper is missing the point of preoperative
assessment. Letter. BMJ 2003;326:600 (15 March).
2. Ross K Kerridge. Unnecessary ritual should not be continued. Letter.
BMJ 2003;326:600 (15 March).
3. Kinley H, Czoski-Murray C, George S, McCabe C, Primrose J, Reilly C, et
al. Effectiveness of appropriately trained nurses in preoperative
assessment: randomised controlled equivalence/non-inferiority trial. BMJ
2002; 325: 1323-1326.
Competing interests:
None declared
Competing interests: No competing interests