Alexander’s Care of the Patient in Surgery 16th Edition

Book Preface

This updated sixteenth edition of Alexander’s Care of the Patient in Surgery reflects new and essential key concepts in perioperative nursing practice and an increased sophistication and complexity in surgical procedures. Its multimedia resource, first introduced in the thirteenth edition, strongly enhances the elemental goal of this textbook: to provide a comprehensive foundational reference that will assist perioperative practitioners to meet the needs of patients they care for safely, cost-effectively, and efficiently during surgical interventions.

As the standard in perioperative nursing for more than 50 years, Alexander’s Care of the Patient in Surgery is written primarily for professional perioperative nurses, but it is also useful for surgical technologists, nursing students, healthcare industry representatives, medical students, interns, residents, and government officials concerned with healthcare issues. Perioperative nurses, RN first assistants, clinical nurse specialists, nurse practitioners, surgeons, and educators from many geographic areas of the United States have served as contributors and reviewers for this text. In doing so, they provide a vast range of perioperative patient care knowledge, procedural information, and wisdom.

This thoroughly revised edition highlights current surgical techniques and innovations. More than 1000 illustrations, including many new photographs and drawings, help familiarize the reader with contemporary procedures, methods, and equipment. Classic illustrations, particularly of surgical anatomy, remain to enhance the text. New to this edition are features highlighting patient engagement and patient-centered communication, the addition of Enhanced Recovery After Surgery protocols, and an expanded emphasis on robotic-assisted surgery. Each chapter contains a summary of Key Points and a Critical Thinking Question. There is a thorough laboratory values appendix in which readers can review normal lab values and ranges. Readers will again find Ambulatory Surgery Considerations; Evidence for Practice; Patient, Family, and Caregiver Education; Patient Safety; Research Highlights; Sample Plan of Care; and Surgical Pharmacology features, updated to reflect changes.

Enhanced in the sixteenth edition is the Evolve website. With its learner resources, readers are able to access animations, The Agency for Healthcare Research and Quality (AHRQ) case studies, answers to the critical thinking questions, interactive study questions, OR Live links, and scenario packets.

Also enhanced in the sixteenth edition are resources for instructors and clinical educators. In addition to the learner resources listed previously, instructor resources contain a lesson plan for each chapter with the following elements: case studies, answers to critical thinking questions, learning objectives, suggested content for lectures and class activities, clinical learning scenarios for each covered surgical procedure, PowerPoint lecture slides with speaker notes, and an image collection of more than 1000 images to use in teaching. Instructors and clinical educators will also find a test bank with more than 750 questions as well as more than 50 customizable competency assessments for use in clinical settings or simulation laboratories as learners practice new perioperative nursing skills and techniques. Overall, this textbook imparts state-of-the-art information and resources to reflect contemporary practice and to promote delivery of comprehensive perioperative patient care.

Unit I, Foundations for Practice, provides information on basic principles and patient care requisites essential for all recipients of perioperative patient care. The nursing process, a model for developing therapeutic nursing interventional knowledge, reflects a six-step method that includes the identification of desired patient outcomes. Interest in patient outcomes and their improvement continues to be an essential element of nursing. The collection  health data requires clear identification of contributions to patient outcomes and quantification of these contributions. Perioperative nurses must continue to link their interventions to outcomes. This relationship is presented in Chapter 1 and explicated in each Sample Plan of Care throughout the text.

Research Highlights continue to be included in every chapter and reflect the steady increase in the amount and quality of research relevant to perioperative patient care. As current findings of new research are important to use in clinical practice, the editors and authors of Alexander’s Care of the Patient in Surgery are committed to supporting this research-practice relationship. The Research Highlights will help perioperative nurses implement research findings in their practice and patient care activities.

Chapter 1 also sets the stage for an emphasis on patient, family, and caregiver education and discharge planning throughout the text. Chapters in Units II and III address specific patient, family, and caregiver education and discharge planning relevant for patients undergoing one or more of the respective specialty surgical procedures. As the responsibilities of perioperative nurses become greater with regard to those important care components, it is imperative that we effectively educate patients, their families, and their caregivers. As length of stay in healthcare facilities continues to decrease, patients, families, and caregivers need more and better information to deal appropriately with postoperative needs after discharge. Pain management, addressed in Chapter 10, also appears in many of the chapters on surgical specialties because all perioperative nurses recognize its importance in patient discharge planning.

Chapter 2 focuses on patient safety and risk management, including a review of the use of social media and patient privacy issues. As members of the perioperative team face increasing workloads and workplace stress, this sixteenth edition emphasizes the need for workplace safety in Chapter 3. When pressure in the surgical suite mounts, perioperative staff may feel the need to work faster, even if it means taking shortcuts. The chapter on workplace safety stresses the need for personal safety at work and explores such issues as noise in the OR, active shooter situations, workplace violence, and bullying. The remaining chapters in Unit I focus on perioperative precepts guiding infection prevention; anesthesia; patient positioning; sutures, sharps, and instruments; surgical modalities; wound healing; and caring for the postoperative patient in the PACU and on the transfer unit.

The chapters in Unit II, Surgical Interventions, include more than 400 contemporary and traditional specialty surgical interventions, with descriptions of open approaches, minimally invasive surgical procedures, and robotic-assisted surgery. Each chapter provides a helpful review of pertinent anatomy and details the steps of surgical procedures. Perioperative nursing considerations are again presented within the nursing process framework. Current NANDA International–approved nursing diagnoses and Sample Plans of Care for each surgical specialty aim to help perioperative nurses plan, implement, and evaluate individualized perioperative patient care. Each of these chapters also provides an example of Evidence for Practice related to the surgical specialty. In 2018 and beyond, perioperative nurses can expect to find a continuing emphasis on evidence-based nursing as a means to provide care that is effective and yields improved outcomes. The integration of evidence-based practice with the perioperative nurse’s individual clinical expertise leads to optimal care provision, the foundation of perioperative patient care. Improving the quality of patient care and effecting safe outcomes are at the heart of all our efforts to achieve excellence in whatever setting we encounter the patient who is undergoing an operative or other invasive procedure.

Incorporation of Surgical Pharmacology in the sixteenth edition reflects the ongoing emphasis on medication safety in the United States. Medication errors can occur anywhere in the medication-use system, from prescribing to administering a drug. Alexander’s Care of the Patient in Surgery joins the nationwide health professional education campaign that aims to reduce the number of common but preventable sources of medication errors. Providing information about select medications and dosages used in surgical specialties, the Surgical Pharmacology feature is intended to promote safe medication practices and to avoid serious, even potentially fatal, consequences of medication errors by perioperative practitioners.

To further facilitate the perioperative nurse’s focus on safe patient care, Patient Safety features in each chapter succinctly review a practice to assist perioperative practitioners in developing a core body of knowledge about safe patient care. We intend for this feature to raise awareness about patient safety applications. We also intend simultaneously to foster communication and ongoing dialogue in perioperative practice settings regarding application of recommended patient safety strategies and use of robust process improvement initiatives. In so doing, we hope to improve quality and safety overall in perioperative patient care.

New to the sixteenth edition is information on Enhanced Recovery After Surgery protocols. These protocols aim to increase efficiency during all phases of perioperative patient care and decrease length of stay for surgery patients and costs of care, while improving outcomes. As applicable to the chapter content, Enhanced Recovery After Surgery features address the evidence-based strategies and merits of such protocols.

The unique needs of pediatric, geriatric, and trauma surgery patients are presented in Unit III, Special Considerations. The
“Interventional and Image-Guided Procedures” chapter reflects processes of care in sophisticated hybrid OR suites, where enhanced capabilities merge open and interventional surgery in a multidisciplinary environment. The “Integrative Health Practices: Complementary and Alternative Therapies” chapter was introduced in the twelfth edition. Perioperative nurses frequently encounter patients who use such therapies, some of which are nonpharmacologic and some of which involve medications. This chapter explores alternative medical systems, mind-body interventions, biologically based therapies, manipulative and body-based methods, and energy therapies. Treatments and systems within each category are discussed.
Many expert perioperative practitioners, RN first assistants, clinical nurse specialists, and educators have contributed to this sixteenth edition, and I owe a debt of gratitude to all of them for sharing their expertise in the development of this text.

I give ongoing thanks to my partner, Alan Zulick, Esquire, for his help during copyediting and page proofs. I also acknowledge the valuable assistance of editors, reviewers, photographers, and illustrators who have contributed their time and expertise to the revision of this text. The team I had the privilege of working with at Elsevier is talented and eager to support perioperative practitioners in their commitment to excellence in patient care. Laura Selkirk, I would clone you and give you as a gift to all of my nurse editor colleagues if I could—you walk the entire journey with each edition of this book with supreme aplomb! Donna McEwen, my Associate Editor, is not only a masterful editor but also an instructional design expert. The Evolve website is the elegant and robust feature that it is due to her acumen and talent. Christine Smith is a clinical nurse specialist who developed the competencies. Mickey Cromb is a registered nurse and instructional designer who developed the test bank. Clearly, I work with a team to be admired and esteemed for their contributions to this edition.

Alexander’s Care of the Patient in Surgery is written by and for perioperative nurses. Its premise is underscored by the clear understanding that perioperative nursing is a caring and intellectual endeavor, requiring critical thinking, technical acumen, and clinical reasoning and decision-making to improving patient outcomes. With the multimedia package accompanying this sixteenth edition, Alexander’s Care of the Patient in Surgery invites you to journey with us as we meet the challenges and opportunities of perioperative nursing in the twenty-first century.

Jane C. Rothrock