NRSG533 - Surgical: Advanced and Complex Surgical Nursing

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 present to increasingly complex and dynamic healthcare environments with various conditions and illnesses that require surgical intervention. The specialist surgical nurse plays an integral role in the patient’s trajectory of care from admission and preparation for surgery, to postoperative management, rehabilitation and discharge. To be able to efficiently and effectively care for patients across the surgical continuum, surgical nurses must have extensive pathophysiological knowledge and proficiency with a range of technical, cognitive and behavioural skills, to understand, apply and develop appropriate plans of care for patients with acute, chronic and complex care needs who require surgery. 

This unit is required by students because surgical procedures present risks for patients that can result in pathophysiological changes, physiological processes and clinical deterioration. It is critical that surgical nurses have advanced knowledge, competency, critical thinking and clinical decision-making skills to recognise altered patient parameters and haemodynamic instability in the surgical patient. It is imperative that surgical nurses can also escalate abnormalities and clinical deterioration in a timely manner and implement the appropriate management and care requirements. Surgical patients are at an increased risk for adverse events during hospitalisation compared to non-surgical patients, due to procedures which can cause abnormal reactions and complications. It is critical that surgical nurses are equipped with the proficient specialist knowledge and skills to effectively advocate, guide and care for surgical patients using evidence-based, ethical practice. Selection of content for this unit is based on a range of surgical procedures, the complexity of pre-operative, intra-operative and postoperative care required by patients undergoing surgical procedures, and recent advances in surgical nursing. Key concepts relating to postoperative complications, haemodynamic stability, haemostasis, fluid and electrolyte imbalance, thermoregulation, cultural and emotional support and rehabilitation will be explored to assist students with skills in analysis, evaluation, and application of informed decision-making. 

The aim of this unit is to support students to evaluate the complexity of surgical nursing 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 - Examine the aetiology of surgical conditions and the impact surgery has on the key pathophysiological concepts that contribute to risk, clinical deterioration and the complex care required for surgical patients (GA3, GA4, GA6, GA8, GA9)

LO2 - Analyse the inter-relationship that national frameworks, surgical safety tools, nursing care delivery and clinical reasoning skills have for mitigating harm in surgical patients (GA2, GA3, GA4, GA5, GA8)

LO3 - Appraise postoperative risk factors for surgical patients and implement strategies to promote haemodynamic stability, haemostasis and airway management (GA4, GA5, GA7, GA8, GA9, GA10)

LO4 - Evaluate the care and education requirements for surgical patients, families and their carers to navigate treatment, management and rehabilitation following complex and traumatic advanced surgical procedures (GA1, GA2, GA4, GA5, GA7, GA8, GA9, GA10)

LO5 - Critique the ethical perspectives, physical and psychosocial impacts, and care needs that are present for surgical patients, and apply this knowledge to inform evidence-based, ethical, family-centred care to promote health, well-being, recovery and dignity in surgical settings (GA1, GA2, GA3, GA4, GA5, GA7, GA8, GA9, GA10)

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:

Neurosurgical nursing

• Raised intracranial pressure
• Herniation
• Cognitive alteration
• Rehabilitation

Opthalmic and ENT surgical considerations

• Cataract surgery
• Otologic surgery
• Nasal & sinus surgery
• Throat surgery
• Maxillofacial surgery
• Nursing management

Head and neck cancer & reconstructive procedures

• Reconstructive procedures
• Surgical flap reconstruction
• Orthognathic surgery 

GIT & hepatobiliary surgical care

• Acute abdomen
• Inflammatory bowel disease
• Oesophageal varices - causes and treatment / cancer / oesphagectomies
• Biliary surgeries and complications
• Abdominal and pleural paracentesis
• Pancreatitis
• Colonoscopy/Gastroscopy
• Liver biopsy / resection
• Radiology interventions as treatment options
• Assessment and management of the patient undergoing abdominal surgery
• Nursing education
• Sexual health (post stoma / post joint surgery for example)

Gynaecological & urinary considerations

• TURPS
• Urinogenital surgical care
• Surgical interventions for common gynaecologic disorders

Complex orthopaedic care

• Spinal surgeries – ACDF / Laminectomies / Microdiscectomies
• Tumours
• Rehabilitation
• Reconstructive Surgery
• Skin, muscle & bone
• Complex reconstruction
• Traumatic injuries
• Knee, hip & pelvis
• Fractures 

Breast cancer & reconstructive procedures

• Mastectomy
• Breast reconstructive options
• Wound and postoperative care
• Psychological care post breast surgery

Organ transplantation 

• Diseases / conditions that cause the need for transplantation
• Pre transplantation preparation
• Living donor vs. deceased donor
• Autologous & allogenic cell collection
• Types of transplant and conditioning regimes
• Engraftment syndrome
• The role of the nurse and multidisciplinary team in organ transplantation
• Complications of transplantation

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. For example, 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 will demonstrate the ability to research and report on a postoperative complication experienced by surgical patients. Knowledge and skills gained in this assessment task are then further developed in the final assessment where students demonstrate the ability to write a critical analysis on complex care trajectories for patients requiring surgery for an acute condition or traumatic injury. Through the application of learned knowledge, critical thinking skills, analysis and synthesis of evidence, students will demonstrate the use of evidence-based practice to promote health and wellbeing in caring for patients with surgical disorders.

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-au.ezproxy2.acu.edu.au/nursing/#!/browse/book/3-s2.0-C20181027031

Rothrock, J., & McEwen, D. (2019). Alexander’s care of the patient in surgery (16th ed.). Elsevier. https://www.clinicalkey.com.au/nursing/#!/browse/book/3-s2.0-C20160004576

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