Nursing Roles in Perioperative Care: A Case Study of Femoral Neck Fracture

This case study discusses the nursing roles involved in perioperative care for a patient with femoral neck fracture. The roles include pre-admission clinic nurse, day-stay unit nurse, anaesthetic nurse, circulating nurse, scrub nurse, and PACU nurse. The essay elaborates on the duties of each nurse and the legal aspects of their roles. The outcome of the surgery depends on the collective efforts of all nursing professionals involved in the perioperative care of the patient.

Running head: MEDICAL SURGICAL NURSING
Case Study 2
Name of the Student
Name of the University
Author Note

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The case study being discussed here is about a seventy year old female Gail, who has
been admitted to the surgical ward following an incident that involved a mechanical fall.
Mechanical falls are most commonly found to occur due to trips, slips, or loss of balance. An
x-ray scan confirmed the presence of femoral neck fracture in the right leg. Femoral neck is
the weakest region of the femur and these fractures are generally considered subsets of
proximal femoral fractures (Langslet, Frihagen, Opland, Madsen, Nordsletten & Figved,
2014). Elastic resistance also reduces in the bones that have been fractured. This essay will
elaborate on six nursing roles, involved in perioperative care (Hamlin, Davies, Richardson-
Tench & Sutherland-Fraser, 2016).
Pre-admission clinic nurse will be involved in complete a comprehensive and
thorough health assessment of the patient, with the aim of ensuring her readiness for the
orthopaedic surgery (LeMone, Burke, Dwyer, Levett-Jones, Moxham & Reid-Searl, 2015).
The role of the nurse encompasses using a set of questionnaires and conducting a range of
tests during the visit, followed by making the results available to the general practitioner
and treating specialist. One major role of the pre-admission clinic nurse would be to work in
collaboration with the anaesthetic and surgical team for ensuring maintenance of optimal
health of the patient and preparing the latter for admission (Bouamrane & Mair, 2014).
Further duties include paperwork regarding the medical history of the patient and medical
insurance, failure to record which can lead to legal disputes. Moreover, the assessment will
also involve infection control by assessing the patient for the presence of nosocomial
infections due to the fall.
Day-stay unit nurses are entitled with the duty of providing care to their respective
patients for a time period of 24 hours or less, across different settings. The same-day nurses
will care for Gail before and after the same-day surgery. The role would encompass using
cost-effective ways for promoting patient health, managing acute or chronic health problem
or preventing health deterioration. She would also promote self-management of the patient
and assist the latter’s friends and family members in taking care of the patient. Following
preparation of the patient for the operation theatre, patient recovery will also be looked
after by this nurse (Wright, Tan, Iliffe & Lee, 2013). Removing hair from the surgical site and
using depilatory creams, and dressing surgical sites are some essential infection control

2MEDICAL SURGICAL NURSING
practices performed by these nurses. Furthermore failure to monitor the patients or keep a
check on their complications can lead to legal trouble.
Anaesthetic nurses are clinically trained and have the necessary educational
credentials for providing care to patients requiring an anaesthesia or pain management,
before a surgery is performed. The nurse will also be involved in administration of the
anaesthetic and preparing the required equipment. In addition, the patient’s condition will
also be monitored, along with presence of adverse reactions in response to the anaesthetic.
Legal aspects of the duty encompass the fact that administration of wrong anaesthetic or
inappropriate doses can lead to medical malpractice and result in lack of oxygen, awakening
or death (Brykczynski, 2014). Decontaminating the surgical equipment, cleaning materials,
disinfection practices, and hand hygiene practices are some of the steps that are expected
from the anaesthetic nurse before and after the surgery (Crosson, 2015).
The duties of a circulating (scout) nurse are generally conducted outside the sterile
region. The CN will manage all important care inside the operation theatre and will provide
assistance to the team with the aim of maintaining and creating a comfortable and safe
environment for the patient. The nurse will have the duty of alerting the surgical team with
the aim of ensuring the presence of adequate surgical supplies, following which they will be
sent to the operation theatre. She will also be imperative in managing and documenting the
supplies, collecting patient specimen (Russ et al., 2015). Verifying the consent form of Gail
and authenticating accountable items are essential legal roles, failure to fulfil which, will
result in violation of patient safety (Lamont, Jeon & Chiarella, 2013). Preparing the surgical
equipment and avoiding intra-surgical complications are some of the infection control
practices encompassed by the duty of a scout.
A scrub nurse ensures that all equipment in the operation theatre are clean and
ready for use, upon patients. She will be responsible for handling the tools and equipment
to the orthopaedic surgeon. Furthermore, she will also have to rapidly and efficiently
response to the requests and hand gestures of the doctors and the surgeon. A legal
complication can arise if the instrument nurse fails to check whether the equipment are
updated and ready to use. Sudden technical faults of the equipment during the surgery can
threaten patient safety. Furthermore, sterilization of equipment is also encompassed by her
role, the primary benefit of which is related to prevention of infection transmission (Jacob,

3MEDICAL SURGICAL NURSING
Li, Akingba & Wachs, 2013). Failure to provide sterile supplies and inattentiveness towards
intraoperative complications will also encroach upon patient safety.
PACU nurses have the responsibility of monitoring post-operative patients, following
their recovery from surgeries in an outpatient setting or a hospital. The nurse will be
involved in managing the vital signs, changing the dressing bandages, and administering the
necessary medications. Furthermore, she would also be in charge of getting a
comprehensive handover from surgical teams and monitoring the patient all along the
perioperative journey. Management of postoperative pain and taking appropriate steps for
nausea relief are other essential duties of the nurse (Hayes & Gordon, 2015). Legal
complications arise when these nurses fail to ensure opening of the patient’s airway, and
taking regular observations of the patient. Furthermore, a PACU nurse will also have the role
of maintaining proper hand hygiene practices in the recovery room, which when not
followed might increase risks of infection.
Thus, it can be concluded that the outcomes of the surgery that is intended to be
conducted on Gail for femoral neck fracture do not depend only on the surgeon, but on
several nursing professionals namely, pre-admission clinic nurse, day stay nurse, anaesthetic
nurse, scout nurse, scrub nurse, and PACU nurse. All these nurses adorn the role of a
caregiver and have the prime duty of providing hands-on care to all patients in a variety of
healthcare settings. Thus, their role would entail assessing the physical needs of the patient,
in addition to helping in illness prevention, maintaining patient safety and preventing
pathogen transmission.

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