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Preoperative Procedures In Nursing
Preoperative Procedures In Nursing
Contents
TOC o “1-3” h z u Preoperative procedures PAGEREF _Toc379384746 h 1The procedure PAGEREF _Toc379384747 h 1The basis of the practice PAGEREF _Toc379384748 h 1Rationale for deciding on the procedure PAGEREF _Toc379384749 h 2Clinical implications of the procedure PAGEREF _Toc379384750 h 2Suggested Changes PAGEREF _Toc379384751 h 3Barriers to implementation PAGEREF _Toc379384752 h 4Celik,S.E & Kara,A.(2007). Does Shaving the Incision Site Increase the Infection Rate After Spinal Surgery? Retrieved March 20,203 from http://www.medscape.com/viewarticle/559891_4 PAGEREF _Toc379384753 h 5
Preoperative proceduresThis involves the care that is given to a patient before, during and after a surgical process. The aim of the procedures is to provide better conditions for surgical patients before they are operated on, during the operation and after the operation. There are some of the preoperative procedures which are conducted in the surgical floor that are questionable. In fact one is left to wonder if some of the procedures have a basis in research. This paper will therefore look at the basis of one of some of these procedures, suggestions on changes that can be made to them and any barriers that might arise when it comes to the implementation of the revised clinical practice guidelines (Rosdahl,., & Kowalski, 2012).
The procedureAmong the preoperative procedures that are questionable is the shaving of areas where incisions of surgery have to be made. This is a routine procedure that is used worldwide by many surgeons before an operation. This is can be done immediately before the surgery or even a day before the operation. The hair removal procedure can be done in various ways including the use of clippers, razor blades for shaving, electric shavers and hair dissolving creams to remove hairs that might be present on the area where an incision has to be made. Before shaving is done there are several pre surgical skin preparations that are done this include full body wash with povidone-iodine or chlorhexidine.
The basis of the practiceThe practice is acceptable by surgeons worldwide and they consider it mandatory. The hospital management and doctors also fall in this category. Therefore the entire management of the hospital is the ones that determine the basis for the procedure since all their colleagues in other hospital worldwide are using it.
Rationale for deciding on the procedureIt is believed that shaving lower the risk of infection of the surgical site which is not really the case. Shaving is also intended to remove anything that might obstruct a surgeon from viewing the area of incision. This will therefore enable the surgeons to easily access the incision site or area. Some surgeons believe that shaving is a way of removing bacteria that are found on the surgical area which could otherwise cause contamination of the surgical area. Another rationale behind shaving of the site of surgery sis the belief that the procedure leads to reduced wound infections, an increase in exposure of incision site at the same time facilitate the dressing and the closing process. There are other cases that are seen to necessitate the removal of hairs such as when there is need for the application of adhesive lads on the skin of the patient before surgery is done. If hair is present then it means that there can be no way that the leads can reach the incision area.
Clinical implications of the procedureResearch has shown that the shaving of skin before surgery raises the risk of infection of the area after the surgery. This is because intensive antibacterial handling that is done before the shaving of the area can cause the disruption of the healthy skin flora at the same time enabling the area to be colonized by pathogenic agents (Celik, & Kara, 2007). At the same time altering of skin flora due to shaving is associated with increased growth of bacteria and eventually leads to infection. The surgical site infections increase complications in patients and they account for most of the infections associated with health-care and eventual death of patients. This therefore shows that this procedure is quite inappropriate. This implies that preoperational shaving procedures should go through some transformations regarding the methods that are utilized in the process of removing hair.
Threat to infection is seen to potentially increase as the length of time between shaving is done and the actual surgery. Shaving that is done in the operating room inflicts micro trauma on a patient’s skin at the site of incision as well as damaging hair follicles that are located on the sites before surgery hence the area becomes susceptible to being colonized by organisms that are infectious. There is a clear indication of an indirect connection between surgical infections and removal of hair before surgery. Therefore it is implied that failure remove hair or shave is away of reducing infections. It is also indicated that incision sites that are hairy do not increase surgical infections. Due to the clinical implications of shaving it is suggested that it is not necessary to remove hair on surgical sites not unless it will interfere directly with the operation.
Suggested ChangesBecause of several implications that come in as a result of shaving on the surgical sites, there are some of the suggested changes that should be taken into consideration to stop those implications. For instance, the nurses should use depilatory creams instead of shaving the patient when there happens to be a necessity of performing the preoperational hair removal. This is because; there are small abrasions as well as cuts associated with shaving which can quickly results to the emergency of the infections. This on the other hand indicates that, the preoperative procedures such as shaving should never be viewed as being highly appropriate and acceptable. However, the justification regarding the procedure may possibly be based on the reasons of humanitarians, for example, in cases where the presence of the hair tends to make it difficult for the surgeons to clearly see the site of incision. The other scenario that may necessitate the removal of hair from the patients by the surgeons is when there may be need of applying the adhesive leads to the skin prior to surgery. Despite of all the suggestions collected from various literature sources, there is still ongoing debates where most people are arguing out on whether it is necessary for the intended surgical sites to be shaved or not (Perry, Potter, & Elkin,2012).
The other significant suggested change is the need to change the staffs’ perception by telling them that, shaving is mainly significant in reducing the risks of the surgical site infections. According to the research conducted in hospital personnel regarding the preoperative shaving procedures, the information collected showed that the main reasons behind shaving is in the fact that the majority of the surgeons believes the procedure may help in reducing the rate of infections as well as enables the ease of access to the point of incision. The data gathered also indicated that the nurses carry out the procedure before or a day before the surgery. However the preferred time is immediately before the surgery is done so as to reduce risks of bacterial infections.
Nurses should use clippers instead of razors when shaving the surgical sites. In this case, they should use hair dissolving creams that is associated with few cases of breaches in skin. The other recommended practice is by carrying out preoperational shaving close to the surgery time that is at most 3 hours before surgery procedure. The suggested change is due to the findings from the data gathered which indicated that, the adverse effects on the wound infection is as a result of shaving. Conversely, hair removal prior to surgery helps in reducing the rate of infection.
Barriers to implementationVarious barriers may arise when implementing the change. The key stakeholders to be included in for decision making in order to transform the preoperative procedure may include the patients, nurses, the health experts and the clinicians. It will be therefore difficult to implement the change unless one gets to know what the stakeholders will say about the changes suggested. Patients on the other hand will be required to air out their views so as to generate new ideas on the methods to be employed during the surgical site hair removal process. The health experts will also help in creating awareness as well as creating the preoperational nurses concerning the merits and the demerits of using surgical site shaving (Altman, 2004).
It is therefore necessary for the one implementing the changes to clearly educate those who are involved in carrying the practices such as the surgeons by communicating effectively on the reasons behind the implementation of the change. The other barrier to implementing change can be as a result of communication breakdown in the organization. For instance communication breakdown can result to information and data misinterpretation. The other barrier may be as a result of lack of support from the leadership team. In most cases, there are people who may be willing to accept change while others will never accept to implement the change. In this case, nurses may be willing to implement the change however they may not get enough support from the senior staffs. To overcome all these problems to change the institution, training as well as effective communication should be put as the main strategies for implementations.
References
Altman, G. (2004). Delmar’s fundamental & advanced nursing skills (2nd ed.). New York: Thomson/Delmar Learning.
Celik,S.E & Kara,A.(2007). Does Shaving the Incision Site Increase the Infection Rate After Spinal Surgery? Retrieved March 20,203 from http://www.medscape.com/viewarticle/559891_4Garber, J. S., Gross, M., & Slonim, A. D. (2010). Avoiding common nursing errors. London: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Perry, A. G., Potter, P. A., & Elkin, M. K. (2012). Nursing interventions & clinical skills (5th ed.). New York: Mosby.
Rosdahl, C. B., & Kowalski, M. T. (2012). Textbook of basic nursing (10th ed.). London: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Premium Cruise Lines
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Premium cruise lines
Cruise ship industry is among the fasters growing segment in the hospitality industry all over the world, with an approximate annual growth rate of about 8.4%. According to darity (2008), in 2007 alone 12.6 million tourists cruise worldwide. This number grew the year after and it was approximately 80 million at end of 2013. At present, there are about 350 premium cruise lines sailing the world’s seas. Premium cruise industry has a number of economic benefits to a port state. These benefits arise from five principles which include; cruise tourist and crew spending, employment by the Premium cruise lines companies, premium cruise lines expenditure on goods and service, which are necessary for cruise operation, cruise line expenditure for port services, and expenditure for premium cruiser maintenance.
Most tourist in the world chooses premium cruise lines because they are smaller as compared to the larger cruise ships and, therefore, take fewer cruisers. The space ratio of the premium cruise lines is greater than the larger one, who make premium cruise lines are less crowded as compared to the greater. Some premium cruise lines, sometimes, characterize themselves up premium cruise. Most premium cruise lines offer larger staterooms and more luxurious bathing facilities as compare to large cruise ship (Dickinson & Vladimir, 2008).
How currents affect premium cruise lines
With the current technologies, premium cruise lines trends are shaping up with a greater focus on multigenerational groups with more unique food offering. Most of these premium ships now offers about a quarter mile boardwalk. Mullins & Walker (2013) show that some Cruise lines carry up to 3600 passengers and still include a jogging track and space for walk. Unlike the ancient premium cruise, modern cruise reflects new trends of being outside all the time with outdoor restaurants, much on-deck seating and other things that will make you be outside most of the time.
Modern technology has made it possible for premium cruiser to offer most luxurious things such as skating rings, planetariums, climbing walls, among other new attractive activities that keep coming. Among the most modern is Crystal symphony, which includes a vertical garden. The other two most competitive premium cruises are carnival Cruise lines and Holland America line cruise. Carnival lines cruise offer TV game, which allows passengers to participate while watching it (Papathanassis, 2012). The carnival cruise lines also include 3-D movies, which are shown on theatres equipped with motion seats, which has special effects like wind and water. America cruise lines, on the other hand, include programming partnership, which are usually used for fitness workout and pool parties.
With advance technology, most premium cruises have expanded food option. Some such as Norwegian have everything from separate bars of Asian noodles, raw shellfish to churrascaria. Most cruise lines also are trying to accommodate diverse needs for youth and adults. They are expanding where youths can have enough exercises and at the same time creating cool places for adults where they can sun, read books, and nap (Peng, 2009).
Lastly in the current trends is the information technology, which has shifted the way travellers book cruise lines. Unlike sometimes back where travellers were forced to book cruise lines with some middlemen, they now book it directly online through cruise’s company branded website.
Effects of cruise industry on economy
The benefits of the cruise industry are derived from income generated from the spending at the port. These incomes, which include money received from dockage, wharfage, and passenger’s spending were originally earned somewhere. In fact, direct purchases by cruise lines and passengers from local business create income and jobs. Local government benefits from the cruise industry through taxes imposed on this sector. In most cases, taxes flow directly from the port authority rather than local government (Walker, 2012)..
Benefits derived from the cruise industry are usually measured by impact analysis, which is based on input-output model. An input-output model calculates effects on the income; employment on the region, and value added which resulted from the original input. Direct and indirect effects that arise from the passenger’s spending become an income the affected local firms. All these incomes are received from the services and goods rendered. That means for a firm to produce and distribute the requisite goods and services, needed by cruise lines, local firms must invest some money. Therefore, if a country’s economy is poor and has less to invest on the cruise business, then the amount obtained from the travellers, are also low. If a country is so poor and fails to invest on this industry, the number travellers wishing to visit such a country will also reduce dramatically (John, 2008).
Social impact of cruise industry:
Premium cruise industry has a social and cultural impact on the destination. This impact is as a result of the relationship between residents and guest. Premium cruise lines have both social and negative impacts and positive impacts.
Cruise lines impact the society positively through culture exchange, labour issues, and revitalization of culture and tradition. Destination gives an opportunity for travellers to learn by visiting museums, cultural centres, and heritage centres. On the other site, social exchange is likely to increase the chances for people to develop mutual sympathy, understanding and tolerance. Therefore, it is clear that tourism can be away for local people to trade he culture and knowledge. The culture of the community can improve cruise industry in many ways. For instance, festivals and events local communities can increase the number of the premium cruise lines visiting a country.
Another positive social effect of the cruise industry is on education. A research show that cruise tourism has promoted and increase educational opportunity. According to Henkens(2006), tourism can also bring a positive force toward peace, and fosters pride in traditional culture that can assist in avoiding urban relocation.
On the negative side, cruise industry may lead to misunderstanding and conflicts. Generally, social impacts of cruise vary from place to place. However, the result can be managed by regulating the number and timing of visitors to avoid disruption of social and economic cycle (Butler, 2010).
Conclusion:
According to Cetron, DeMicco, & Davies (2006), it is undeniable that the premium cruise industry brings money to the local economy, however, ensuring development of the cruise industry at the destination require much capital. Therefore, the question is, do the cruise lines bring fewer benefits that the initial cost?
As could be seen, we have to make a decision that pressure to promote cruise industry. However, there is no policy in most government imposed to control the impact of such activity. Lack of planning allows confronting the massive arrival of cruise tourism will eventually lead negative effects in the destinations. Ports too often say those cruises are more important to them than the way they are important to the cruise lines. With the recent growth in the cruise industry, more ports need to be build (Conrady & Buck, 2009).
References
Butler, M. (2010). Cruise tourism: current situation and trends.. Madrid: World Tourism Organization.Cetron, M., DeMicco, F., & Davies, O. (2006). Hospitality 2010: The future of hospitality and travel.. Upper Saddle River, NJ: Pearson/Prentice Hall.Conrady, R., & Buck, M. (2009). Trends and issues in global tourism 2009. Berlin: Springer.Customer-to-customer interaction : impact on cruise experience and overall vacation satisfaction. (2008). Oxford Press: John.
Darity, W. A. (2008). International encyclopedia of the social sciences (2nd ed.). Detroit, Mich.: Macmillan Reference USA.
Dickinson, B., & Vladimir, A. (2008). Selling the sea an inside look at the cruise industry (2nd ed.). Hoboken, N.J.: Wiley.Mullins, J. W., & Walker, O. C. (2013). Marketing management: a strategic decision-making approach (8th ed.). New York: McGraw-Hill.
Papathanassis, A. (2012). Cruise tourism and society a socio-economic perspective. Berlin: Springer.Peng, Q. (2009). International Conference on Transportation Engineering, 2009 Proceedings of the Second International Conference on Transportation Engineering, July 25-27, 2009, [Southwest Jiaotong University] Chengdu, China. Reston, VA: American Society of Civil Engineers.Walker, J. R. (2012). Introduction to hospitality management. s.l.: Prentice hall.
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R. L. (2013). The Globalization of Cost-Benefit Analysis in