NRSG532 - Surgical: Comprehensive Care for Surgical Patients

Year

Credit points

Campus offering

Prerequisites

NRSG524 Advanced Pathophysiology for Specialty Nursing Practice AND NRSG525 Evidence-based, Person-centred Family Care in Specialty Nursing Practice

Unit rationale, description and aim

Patients requiring surgical procedures often present to hospital with a range of pathophysiological and psychosocial changes, and comorbid conditions that predispose them to various risk factors, post operative complications and risk of deterioration. In surgical nursing, patients can require complex, person-centred and multidisciplinary care. To be effective healthcare practitioners, nurses working in surgical settings must have pathophysiological knowledge and a range of skills, to understand, apply and develop an appropriate plan of care for patients with acute, chronic and complex care needs undergoing surgery.

It is critical that surgical nurses are equipped with the specialty knowledge and skills to effectively care for surgical patients through application of evidence-based practice. Selection of content is based on the complexity of care required by surgical patients and the recent advances in surgical nursing. Key concepts related to surgical comorbidities, common surgical procedures, risk assessment and mitigation, early recognition and escalation of deterioration, timely implementation of interventions, surgical management of acute and chronic health conditions and rehabilitation will be explored to assist students with skills in analysis, evaluation, and application of person-centred care in the surgical setting.

The aim of this unit is to support students to evaluate the complexity of surgical care while developing knowledge and skills to critically appraise and evaluate evidence to ensure surgical patients are delivered high quality and safe care, that is respectful and promotes health and wellbeing.

Learning outcomes

To successfully complete this unit you will be able to demonstrate you have achieved the learning outcomes (LO) detailed in the below table.

Each outcome is informed by a number of graduate capabilities (GC) to ensure your work in this, and every unit, is part of a larger goal of graduating from ACU with the attributes of insight, empathy, imagination and impact.

Explore the graduate capabilities.

On successful completion of this unit, students should be able to:

LO1 - Analyse specialist clinical nursing knowledge and skills, interprofessional communication and teamwork in the specialist clinical setting (GA4, GA5, GA7, GA10)

LO2 - Examine the impact that comorbidities have on the patient’s surgical experience, whilst critically reflecting upon the key pathophysiological concepts that contribute to complex care trajectories (GA3, GA4, GA8, GA9)

LO3 - Assess the risk factors for patients undergoing surgical procedures and appraise and implement a range of assessment techniques and strategies used for harm mitigation (GA4, GA5, GA8, GA9)

LO4 - Appraise and apply the evidence underpinning preventative, curative and rehabilitative approaches to care for surgical patients (GA8, GA9)

LO5 - Discuss the ethical perspectives of providing holistic care to patients undergoing life altering surgical procedures, and evaluate how they influence the surgical patient’s health and wellbeing (GA1, GA2, GA5, GA6, GA8)

Graduate attributes

GA1 - demonstrate respect for the dignity of each individual and for human diversity

GA2 - recognise their responsibility to the common good, the environment and society 

GA3 - apply ethical perspectives in informed decision making

GA4 - think critically and reflectively 

GA5 - demonstrate values, knowledge, skills and attitudes appropriate to the discipline and/or profession 

GA6 - solve problems in a variety of settings taking local and international perspectives into account

GA7 - work both autonomously and collaboratively 

GA8 - locate, organise, analyse, synthesise and evaluate information 

GA9 - demonstrate effective communication in oral and written English language and visual media 

GA10 - utilise information and communication and other relevant technologies effectively.

Content

Topics will include:

Surgical comorbidities

• Common comorbidities in surgical patients
• Nursing assessment
• Surgical risk stratification - including patients past history

Pre-operative care/professional concepts

• Pre-operative care assessment skills
• Multidisciplinary team approach (Allied Health / liaison nurse / case management roles understanding / preparation for elective patient work ups)
• Pre-operative patient education
• Recognising & managing clinical deterioration
• Early warning detection systems
• Communication & clinical handover
• Accountability
• Continuous quality improvement for harm mitigation = risk assessment

Trauma and orthopaedic nursing

• Response to injury & trauma
• Surgical management of trauma – non-orthopaedic
• Surgical management of trauma – orthopaedic
• Osteoarthritis
• Joint replacements
• Nursing management of the orthopaedic surgical patient

Cardiac and vascular conditions

• Cardiothoracic & cardiac surgery
• Cardiopulmonary bypass
• Coronary artery bypass grafting
• Postoperative care
• Surgical nursing
• vascular 
• revascularisation

Postoperative care

• Airway management – tracheostomies
• Fluid & electrolyte management
• Falls risk 
• Delirium management
• Pressure injury prevention
• Postoperative nutrition requirements
• Wound and drain tube management

Paediatric considerations

• Common paediatric surgical presentations
• Preop care of the paediatric patient
• Post op care of the paediatrics patient
• The of the nurse in a paediatric surgical setting

Postoperative complications & emergencies

• Cardiac complications
• Haemorrhage / infarction / death of organ / tissue
• Respiratory complications
• GIT complications
• AKI
• Sepsis
• Acute Compartment Syndrome
• Rhabdomyolysis
• Fat Embolism Syndrome

Learning and teaching strategy and rationale

This unit is offered in online mode and uses an active and collaborative learning approach to support students to analyse and critically evaluate approaches to providing evidence-based, ethical nursing care within a surgical nursing setting. Students will engage in readings and reflections, e-Learning activities and opportunities to collaborate with peers in an online environment. This can involve, but is not limited to, online discussion forums, chat rooms, guided reading and webinar sessions. In addition, e-Learning and links to electronic readings will be provided to guide students’ reading and extend other aspects of online learning.

Through an online learning platform, students will have the opportunity to reflect on the complexity of delivering person-centred care to patients in surgical settings. Online learning in this unit will be supported by the provision of opportunities for students to attend online webinar sessions that allow synchronous exchange of information and facilitate responses to queries generated by students in relation to unit content. For those unable to participate in synchronous webinar sessions, recordings will be available.

Students are required to complete online activities and assessments to demonstrate the application of knowledge. The learning and teaching strategy used in this unit allows flexibility for students while ensuring they have expert support. These modes of delivery assist students in linking knowledge and skills to the surgical nursing context, and to develop shared meanings through online experiential reflections and discussions.

Assessment strategy and rationale

In order to successfully complete this unit, a minimum combined total grade of all assessment tasks of 50% is required to pass this unit.

The assessment strategy used in this unit encourages depth of learning and provides the students the opportunity to develop their capacity to interpret, translate, apply and evaluate evidence-based care provision in surgical settings. In order to develop surgical nursing knowledge and skills required to achieve the learning outcomes and graduate attributes, students first demonstrate the ability to participate in peer review and create an e-Poster presentation on a common surgical risk that is associated with comorbid conditions in the surgical patients. Knowledge and skills gained in this assessment task are then further developed in the final assessment where students demonstrate the ability to undertake a case study review on a patient requiring a surgical intervention. Through the application of learned knowledge, critical thinking skills, analysis and synthesis of evidence, students will develop a comprehensive plan of care that addresses risk management, treatment and prevention strategies that promote physical and psychosocial health, and well-being for patients undergoing surgical interventions.

Overview of assessments

Representative texts and references

Abraham, J., Gulley, J. & Allegra, C, J. (2019). The Bethesda handbook of clinical oncology (5th ed.). Wolters Kluwer. https://ebookcentral.proquest.com/lib/acu/detail.action?docID=5762697

Barash, P.(ed). (2017). Clinical anesthesia (8th ed.). Wolters Kluwer. https://acu-edu- primo.hosted.exlibrisgroup.com/permalink/f/7pr622/61ACU_ALMA51122808060002352

Brown, D., Edwards, H., Buckley, T., & Aitken, R. (2020). Lewis’s Medical-Surgical Nursing ANZ. Elsevier Australia. https://www.clinicalkey.com/student/nursing/content/toc/3-s2.0-C20170033220

Clarke, S., & Santy-Tomlinson, J. (2014). Orthopaedic and trauma nursing: An evidence-based approach to musculoskeletal care. Wiley Blackwell. Retrieved from https://ebookcentral.proquest.com/lib/acu/detail.action?docID=1740751

Hamlin, L., Richardon-Tench, M., Davies, M., & Gillespie, B. M. (2015). Perioperative nursing: an introductory text (2nd ed). Mosby Elsevier. https://ebookcentral.proquest.com/lib/acu/detail.action?docID=1722309

Hoffmann, T., Bennett, S., & Del Mar, C. (2017). Evidence-based practice across the health professions (3rd ed.). Elsevier. https://www-clinicalkey-com-au.ezproxy1.acu.edu.au/nursing/#!/browse/book/3-s2.0-C20160032369

Odom-Forren, J. (2018). Drain’s Perianesthesia nursing: A critical care approach (7th ed.). Elsevier. https://www.clinicalkey.com.au/nursing/#!/browse/book/3-s2.0-C20140036726

Patton, K., & Thibodeau, G. (2019). Anatomy & physiology (10th ed.). Elsevier/Mosby. https://www.clinicalkey.com/student/nursing/content/toc/3-s2.0-C20181027031

Rothrock, J.(2023). Alexander’s care of the patient in surgery (17th ed.). Elsevier. https://www.clinicalkey.com.au/nursing/#!/browse/book/3-s2.0-C2019004928X

Thorne, C. H. M., Gurtner, G. C., Chung, K. C., Gosain, A., Mehrara, B. J., Rubin, P., & Spear, S. L. (2014). Grabb & Smith’s plastic surgery (8th ed.). Wolters Kluwer. https://acu.primo.exlibrisgroup.com/permalink/61ACU_INST/13lm7d8/alma991013149644202352