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A critical examination of an increasingly vital role in surgical practice Surgical first assistants (SFAs) are registered nurses or operating department practitioners (ODPs) who play a crucial role in the operating theatre during surgical procedures. Under the direct supervision of the operating surgeon, an SFA provides continuous skilled assistance, performing a range of established responsibilities to assist the surgeon predominantly in the intraoperative phase of the patient's journey, but also in the pre- and post-operative phases. The role affords theatre nurses and ODPs the…mehr
A critical examination of an increasingly vital role in surgical practice
Surgical first assistants (SFAs) are registered nurses or operating department practitioners (ODPs) who play a crucial role in the operating theatre during surgical procedures. Under the direct supervision of the operating surgeon, an SFA provides continuous skilled assistance, performing a range of established responsibilities to assist the surgeon predominantly in the intraoperative phase of the patient's journey, but also in the pre- and post-operative phases. The role affords theatre nurses and ODPs the opportunity to expand their clinical responsibilities and provide assistance for patients undergoing surgery by undertaking post-qualifying education. More recently, an understanding of the knowledge and skills of the SFA role has been embedded into the undergraduate curricula for ODPs.
Surgical First Assistant: The Essentials of Practice provides a comprehensive and critical examination of the knowledge, skills and behaviours that are required by SFAs to ensure patient safety and quality care. Beginning with a historical overview of the SFA role, it proceeds to outline the legal, ethical and professional aspects of the role which allows the practitioner to critically reflect on SFA practice. It also offers an in-depth analysis of the SFA's responsibilities as defined by the Perioperative Care Collaborative through each phase of the patient's perioperative journey from pre-operative assessment to post-operative pain management.
Surgical First Assistant readers will also find:
A text aligned with UK national standards and best practice
Detailed discussion of topics including pre-operative preparation with the operating theatre, assisting with haemostasis, and many more
An approach which explores both the technical and non-technical skills required by the SFA
Surgical First Assistant is ideal for registered nurses, ODPs, student and apprentice operating department practitioners.
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Autorenporträt
Julie Quick, MSc, NMP, SCP, RN, is Senior Lecturer in Operating Department Practice at Birmingham City University, Birmingham, UK. Mark Owen, SFA, ODP, is Senior Lecturer in Operating Department Practice at the University of Gloucestershire, Cheltenham, UK.
Inhaltsangabe
List of Contributors xi Foreword xiii Preface xv Acknowledgements xvii Part I Essential Concepts of Surgical First Assistant Practice 1 Chapter 1 The Historical Context of the Surgical First Assistant 3 Julie Quick and Mark Owen The Role of the Non-Medical Surgical Assistant During Conflict 3 Lewin's Report 4 Certification 5 National Accreditation 5 National Association of Assistants in Surgical Practice 6 Call for Clarity Over Names 7 A National SFA Toolkit 8 Accredited University Courses 8 The Responsibilities of the SFA 9 References 10 Chapter 2 Ethical, Legal and Professional Considerations of the SFA Role 13 Mark Owen and Julie Quick Autonomy 14 Beneficence 14 Nonmaleficence 14 Justice 14 Case Studies 14 Scenario 1 14 Signpost 16 Scenario 2 16 Signpost 17 Scenario 3 17 Signpost 18 Scenario 4 18 Signpost 19 References 19 Part II The Perioperative Role of the SFA 21 Chapter 3 Preoperative Assessment 23 Jenny Abraham Preoperative Assessment 24 Patient Education 26 Venous Thromboembolism Risk Assessment 29 Tissue Viability 30 Patient Mobility 31 Ward Preparation - Patient Fasting 31 Fasting Instructions for Adult Elective Surgery Patient 31 Fasting Instructions for Adult Emergency Surgery Patient 31 Fasting Instruction for Children 32 Surgical Site Marking 32 Decision-Making and Informed Consent 33 References 35 Chapter 4 Pre-operative Preparation of the Patient Within the Operating Theatre 41 Dave Lawson Introduction 41 Team Brief 42 Timeout 43 Patient Positioning 43 Skin Preparation 45 Chlorhexidine Gluconate 45 Povidone-Iodine 45 Draping the Patient 46 Conclusion 47 References 47 Chapter 5 Assisting with Surgical Incisions and Wound Closure 49 Carolina Britton Surgical Incisions 49 Before Knife-to-Skin 49 Site and Length of Incision 51 Choice of Instruments for Surgical Incision 52 Minimally Invasive Surgery 53 Skin Marking 53 Common Types of Surgical Incisions 54 Assisting with the Surgical Incision 55 Wound Closure 55 Types of Surgical Wounds 56 Wound Healing 56 Wound Closure 57 Techniques for Skin Closure 58 Suturing 58 Other Closing Devices 58 Assisting with Wound Closure 58 Closing a Surgical Wound 59 Wound Drainage 60 References 61 Chapter 6 Assisting with Haemostasis During Surgery 65 Georgina Lewis Introduction 65 Pressure 66 Suction and Visual Access 67 Sutures 67 Clips and Ties (Arterial Clamps) 67 Single Use Clips 69 Surgical Stapling Devices 69 Diathermy 69 Ultrasonic Devices 71 Laparoscopic and Haemostasis 72 Pharmacological Methods And Haemostatic Agents 72 Conclusion 73 References 73 Chapter 7 Tissue Handling and Retraction 77 Lee Rollason and Julie Quick Introduction 77 Tissue Viability Assessment 78 Tissue Types 78 Skin 78 Adipose Tissue 78 Muscle 79 Organs 79 Vasculature and Nerves 79 Bone 79 The Responsibilities of The Sfa 80 Handling of Tissue 80 Types of Retractor 81 Retraction by Hand 81 Hand-Held Retractors 82 Self-Retaining Retractors 82 Implications of Tissue Handling And Retraction 83 References 83 Chapter 8 Instrument Handling for the Surgical First Assistant 87 Susan Hall and Mark Robertshaw Introduction 87 The Use of Handheld Retractors 88 Retracting Away from Oneself 90 Retracting Towards Oneself 90 Tissue Forceps 90 Skin Hooks 91 Handling Artery Forceps 91 Suture Scissors 92 Minimal Access Surgery 95 Other Instruments Requiring Consideration 96 The Practitioner with Extended Skills 97 Toothed Dissecting Forceps 97 Needle Holders 98 References 98 Chapter 9 Wound Management 99 Julie Quick and Mark Owen Introduction 99 Acute and Chronic Wounds 100 Wound Healing 100 Phase 1 101 Phase 2 101 Phase 3 101 Phase 4 101 Haemostasis 101 Inflammation 101 Proliferation 102 Remodelling/Maturation 102 Local Factors 103 Systemic Factors 103 Biopsychosocial Factors 104 Wound Care 104 Patient Education 105 Wound Assessment 105 Anatomic Location and Type of Wound 105 Degree of Tissue Damage 106 Wound Bed and Edges 106 Wound Size and Peri-wound 106 Signs of Infection 106 Pain 107 Dressings 107 Self-Adhesive Absorbent Dressings 107 Soft Paraffin Gauze 107 Alginates 108 Negative Pressure Wound Therapy 108 Conclusion 108 References 108 Chapter 10 Pain Management 111 Felicia Cox and Nisha Bhudia Introduction 111 Defining Pain 111 Classifying Pain 112 Assessing Pain 114 Tools 115 Pain Assessment Questions Using PQRST 115 Example of a Functional Activity Scale 116 Managing Pain 116 Approaches to Analgesia 117 Unrelieved Pain 117 Role of the Inpatient Pain Management Service 117 Patient Education 118 Analgesic Medicines 118 Multimodal Analgesia 118 Paracetamol 118 Opioids 119 Gabapentinoids 120 Alpha-2 Agonists: Clonidine and Dexmedetomidine 121 Ketamine 121 Local Anaesthetics 121 Nerve Blocks 122 Neuraxial Analgesia 122 Fascial Plane Blocks 122 Conclusion 123 References 123 Part III Human Factors and Non-technical Skills 127 Chapter 11 Human Factors 129 Ally Ackbarally Introduction 129 Implications of Human Factors 130 Patient Safety In Surgery 133 Human Error 134 Patient Safety Incident Response Framework 136 SFA's well-being 136 Conclusion 137 References 137 Chapter 12 Non-technical Skills 141 Mandy Mangham and Julie Quick Introduction 141 Classification of Non-technical Skills 142 Situation Awareness 142 Communication and Teamwork 143 Task Management 145 Leadership and Decision-Making 145 Managing Stress and Fatigue 146 References 146 Index 151
List of Contributors xi Foreword xiii Preface xv Acknowledgements xvii Part I Essential Concepts of Surgical First Assistant Practice 1 Chapter 1 The Historical Context of the Surgical First Assistant 3 Julie Quick and Mark Owen The Role of the Non-Medical Surgical Assistant During Conflict 3 Lewin's Report 4 Certification 5 National Accreditation 5 National Association of Assistants in Surgical Practice 6 Call for Clarity Over Names 7 A National SFA Toolkit 8 Accredited University Courses 8 The Responsibilities of the SFA 9 References 10 Chapter 2 Ethical, Legal and Professional Considerations of the SFA Role 13 Mark Owen and Julie Quick Autonomy 14 Beneficence 14 Nonmaleficence 14 Justice 14 Case Studies 14 Scenario 1 14 Signpost 16 Scenario 2 16 Signpost 17 Scenario 3 17 Signpost 18 Scenario 4 18 Signpost 19 References 19 Part II The Perioperative Role of the SFA 21 Chapter 3 Preoperative Assessment 23 Jenny Abraham Preoperative Assessment 24 Patient Education 26 Venous Thromboembolism Risk Assessment 29 Tissue Viability 30 Patient Mobility 31 Ward Preparation - Patient Fasting 31 Fasting Instructions for Adult Elective Surgery Patient 31 Fasting Instructions for Adult Emergency Surgery Patient 31 Fasting Instruction for Children 32 Surgical Site Marking 32 Decision-Making and Informed Consent 33 References 35 Chapter 4 Pre-operative Preparation of the Patient Within the Operating Theatre 41 Dave Lawson Introduction 41 Team Brief 42 Timeout 43 Patient Positioning 43 Skin Preparation 45 Chlorhexidine Gluconate 45 Povidone-Iodine 45 Draping the Patient 46 Conclusion 47 References 47 Chapter 5 Assisting with Surgical Incisions and Wound Closure 49 Carolina Britton Surgical Incisions 49 Before Knife-to-Skin 49 Site and Length of Incision 51 Choice of Instruments for Surgical Incision 52 Minimally Invasive Surgery 53 Skin Marking 53 Common Types of Surgical Incisions 54 Assisting with the Surgical Incision 55 Wound Closure 55 Types of Surgical Wounds 56 Wound Healing 56 Wound Closure 57 Techniques for Skin Closure 58 Suturing 58 Other Closing Devices 58 Assisting with Wound Closure 58 Closing a Surgical Wound 59 Wound Drainage 60 References 61 Chapter 6 Assisting with Haemostasis During Surgery 65 Georgina Lewis Introduction 65 Pressure 66 Suction and Visual Access 67 Sutures 67 Clips and Ties (Arterial Clamps) 67 Single Use Clips 69 Surgical Stapling Devices 69 Diathermy 69 Ultrasonic Devices 71 Laparoscopic and Haemostasis 72 Pharmacological Methods And Haemostatic Agents 72 Conclusion 73 References 73 Chapter 7 Tissue Handling and Retraction 77 Lee Rollason and Julie Quick Introduction 77 Tissue Viability Assessment 78 Tissue Types 78 Skin 78 Adipose Tissue 78 Muscle 79 Organs 79 Vasculature and Nerves 79 Bone 79 The Responsibilities of The Sfa 80 Handling of Tissue 80 Types of Retractor 81 Retraction by Hand 81 Hand-Held Retractors 82 Self-Retaining Retractors 82 Implications of Tissue Handling And Retraction 83 References 83 Chapter 8 Instrument Handling for the Surgical First Assistant 87 Susan Hall and Mark Robertshaw Introduction 87 The Use of Handheld Retractors 88 Retracting Away from Oneself 90 Retracting Towards Oneself 90 Tissue Forceps 90 Skin Hooks 91 Handling Artery Forceps 91 Suture Scissors 92 Minimal Access Surgery 95 Other Instruments Requiring Consideration 96 The Practitioner with Extended Skills 97 Toothed Dissecting Forceps 97 Needle Holders 98 References 98 Chapter 9 Wound Management 99 Julie Quick and Mark Owen Introduction 99 Acute and Chronic Wounds 100 Wound Healing 100 Phase 1 101 Phase 2 101 Phase 3 101 Phase 4 101 Haemostasis 101 Inflammation 101 Proliferation 102 Remodelling/Maturation 102 Local Factors 103 Systemic Factors 103 Biopsychosocial Factors 104 Wound Care 104 Patient Education 105 Wound Assessment 105 Anatomic Location and Type of Wound 105 Degree of Tissue Damage 106 Wound Bed and Edges 106 Wound Size and Peri-wound 106 Signs of Infection 106 Pain 107 Dressings 107 Self-Adhesive Absorbent Dressings 107 Soft Paraffin Gauze 107 Alginates 108 Negative Pressure Wound Therapy 108 Conclusion 108 References 108 Chapter 10 Pain Management 111 Felicia Cox and Nisha Bhudia Introduction 111 Defining Pain 111 Classifying Pain 112 Assessing Pain 114 Tools 115 Pain Assessment Questions Using PQRST 115 Example of a Functional Activity Scale 116 Managing Pain 116 Approaches to Analgesia 117 Unrelieved Pain 117 Role of the Inpatient Pain Management Service 117 Patient Education 118 Analgesic Medicines 118 Multimodal Analgesia 118 Paracetamol 118 Opioids 119 Gabapentinoids 120 Alpha-2 Agonists: Clonidine and Dexmedetomidine 121 Ketamine 121 Local Anaesthetics 121 Nerve Blocks 122 Neuraxial Analgesia 122 Fascial Plane Blocks 122 Conclusion 123 References 123 Part III Human Factors and Non-technical Skills 127 Chapter 11 Human Factors 129 Ally Ackbarally Introduction 129 Implications of Human Factors 130 Patient Safety In Surgery 133 Human Error 134 Patient Safety Incident Response Framework 136 SFA's well-being 136 Conclusion 137 References 137 Chapter 12 Non-technical Skills 141 Mandy Mangham and Julie Quick Introduction 141 Classification of Non-technical Skills 142 Situation Awareness 142 Communication and Teamwork 143 Task Management 145 Leadership and Decision-Making 145 Managing Stress and Fatigue 146 References 146 Index 151
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