Advanced Scrub Practitioner
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The responsibilities and duties of the entire healthcare professionals have altered significantly over the last decade, in particular among the role of nurse in health care practice. Rapid advances in health care technologies and innovative models of healthcare delivery and patient services into the modern healthcare remain as a key element into the changes (Rao 2002). Other key drivers include for example, reducing waiting time for any surgical treatments stimulate the invention of increasing day surgical procedures that too influenced the role of nurse in surgical settings (Heaton 2007). Such newer models of care delivery promoted nurses to perform advancing duties in the area of preoperative nursing and created newer job specifications for instance Advanced Scrub Practitioner (ASP) which often referred as the first assistant (Owen-Jones 2004). However, these newer role developments were developed with the core principles of offering holistic care, being responsible and accountable for one’s personal actions, developing professional proficiency, and serving patients’ interests at all times (NMC 2010). Despite these, these new role as an ASP also has various challenges that were/will be posed while they are in practice includes, professional accountability, legal issues, duty of care, as well as autonomy (Owen-Jones 2004). This paper will evaluate the role of the Advanced Scrub Practitioner and its potential impact on surgical services.
In practice, the ASP works with the team of surgical practitioners during the intra-operative care of patients. The practitioner is working as component of the working theatre team; he/she provides support to the surgeon during the surgical procedure. The role of Advanced Scrub Practitioner (ASP) can be described as `the function assumed by a proficient health care practitioner who provides skilled and competent support under the express administration of the working surgeon although not executing any type of surgical intercession` (Timpany & McAleavy 2010).
The Perioperative Care Collaborative (PCC 2002) stated that `the duty of the ASP has to be assumed by an experienced practitioner who actually has obtained recognized preparation for this position and he/she is conscious that patient healthcare is vital`. Indeed, some argue that this new role has provided nurses to perform a holistic healthcare to every patient (Deighton 2007).
Recently nursing profession has developed extensively towards covering all practical actions in harmony with socio-economical, political, and technological rapid change. The Advanced Scrub Practitioners are also a component of these inclusive nursing activities. Moreover, outstandingly in the surgery theatre the position of the ASP becomes quite varied due to several reasons where for instance, the diverse regulations and rules characterize the specific role of ASP within the surgery theatre and these functionalities are also generated differently. In addition, from the professional, ethical, or legal perception of the ASP role in the perioperative setting has develop into in complicated and new challenges. The shifting boundaries of proficient accountability and its authority on their range of nursing practice have majorly been emerged.
Al-Hashemi (2007) states the role of ASP in the operating department, day surgery division, and operating room (Al-Hashemi 2007), budgetary responsibilities which includes patient’s valuables, supplies ordering, and the secure use of extremely compound and costly equipment and operate in the paramount welfare of every patient in circumstances where they are incapable to formulate an informed option for themselves (Brame 2011). More so, they help in coordinating with external agencies and multidisciplinary team to ensure successful operation of the surgery department. Supervisory responsibilities and staff management for learners, un-registered, registered, and new staff on a daily basis is another role of the ASP and they too provide review, preparation, execution and valuation of evidence-founded care employing high level judgement, skills, and knowledge.
The key clinical skills that Advanced Scrub Practitioner perform includes the following although are not restricted to: haemodynamic monitoring, helping with haemostasis so as to preserve and secure a plain and workable operating field, female/male catheterisation, draping, maintaining airway (frequent suctioning) , handling instruments, and skin preparation before a surgery operation.
Other roles within the operation department consist of: improving the communication link between ward, patient, and theatre, together with pre-operative evaluation as well as post-operative patient care assessment, supporting with patients’ arrangement, including tissue feasibility assessment, transfer patient to the recovery room, enabling surgeon to perform micro surgical interventions by holding camera for negligible enveloping access surgical procedure and cutting of ties and sutures (Deighton 2007). In some health facilities within the UK, the ASP is responsible for utilization and safeguarding of specific surgical apparatus appropriate to region of working, handling of both organs and tissue for access or exposure, indirect use of electrocautery beneath supervision, tissue and skin retraction, assistance with abrasion closure, and application of bandage to the patient (Al-Hashemi 2007).
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Other clinical skills include suturing the skin or even supplementary tissue layers, application of cast bandages, or express electro diathermy to patient’s body tissues, are the responsibility of a specialized surgical practitioner and all of them are not in with the concern of this functionality statement. Moreover, the Advanced Scrub Practitioner works inside a restricted clinical authority framework, even though principally in the intra-operative part (Brame 2011).
The Perioperative Care Collaborative has over the years made significant recommendations on the strict roles of an ASP (Al-Hashemi 2007). One of these suggestions is that any Advanced Scrub Practitioner taking up this responsibility has to have comprehensible comprehensive competencies, and skills and more importantly underpinning knowledge that gained from their recent skilled theatre practitioner experience (Al-Hashemi 2007). Therefore, practitioners are required to produce a full time learning experience in the perioperative area prior to undertaking an authenticated course of learning for this particular role. The PCC (2003) goes further to advocate that the position of an ASP have got to be taken up by a highly competent and knowledgeable practitioner who apparently has obtained acknowledged education in similar role, and it might be via a superficially corroborated course or even an inside-house programme (Al-Hashemi 2007).
The Perioperative collaborative admits that contact to authenticated training in ASP role perhaps could be limited, however recommends that using organisations guarantee that accessibility to such education is made possible for practitioners who are assuming the ASP function.
This move basically ensures that the patient’s wellbeing or rather safety isn’t brought into danger or disrepute by a rank of medical practice which is lower than that of a therapeutic practitioner in addition to ensuring that all the registered practitioners are able to exhibit their aptitude in accord with the needs of their respective specialized registration, prospective service with other health related organisations or in the itinerary of whichever external or internal investigations.
Moreover, any affiliate of the healthcare staff who takes on the responsibility of the Advanced Scrub Practitioner ought to guarantee that their proficient protection insurance will grant cover for taking up this position at the entire time. The body further urges that the listed Practitioner should not presuppose that a medical doctor or rather surgeon is inevitably legally accountable for their activities when working as an ASP.
The U.K. law stipulates that whoever presents the healthcare is wholly answerable for the kind of care given. The Perioperative practitioners have to uphold responsibility for their conduct in the field of nursing with respect to their appropriate ‘Professional Codes of Conduct’. Thus they ought to at all time act to recognize and lessen any threat to patients as well as keep up their obligation of care towards the patient. As a result, they should preserve the professional right to decline to embark on the position of the ASP if they at all suppose that they at any means not capable to assume this role.
The Advanced Scrub Practitioner occupation is governed by a number of legal, ethical, and professional aspects and basically all the perioperative practitioners ought to observe and adhere to each and every one of them. The significance of professional stndards and codes of practice together with subjects relating to professional responsibility and delegation are extremely crucial in this practice and especially during this era where there is mounting claims of clinical negligence in the country costing settlements of more than £863 million during the 2010/11 year. Moreover, there is an employment law which regulates how things are done in this line of work and they all have to be abided to at all times (Pirie 2012).
The Perioperative practice or rather the nursing activities which are carried out in the surgery theatre have been on the growing trend as a standalone profession and has been improving with regards to standards plus applicants. The Advanced Scrub Practitioners have been exposed to further teaching or rather training so as to become accustomed to the current condition of healthcare at each aspect. This is so because the deficiency of full understanding concerning the ASP may direct to an unconstructive result of the practicing care professional.
The inventive framework with respect to the ASP nursing profession presents the prospect to the social and health care which is closely related to the other theatre practitioners. Therefore the ASP generally desires to expand their proficient role by achieving practice and further skills. It ought to be clearly confirmed that a mere reflection of any significant event in the majority of the issues helps in recognizing the experience and knowledge and as well motivations which steer the ASP during the occurrence. Through connecting similar events, the practitioners are provided with the professional and personal development and the perioperative knowledge and practice gaps are able to be exposed.
Conventionally, the surgeons have been being assisted mainly by the professional nurses. Many people are aware that the ASP scrub nurses perform their daily work regularly with the medical surgeon within the sterilized field as they apparently offer the surgery doctor the necessary equipment using their trained assistance. As a result, the ASP becomes solely responsible for everything that is needed by the surgeon amongst the other roles stipulated for the practitioner while in the department’s operation theatre. Even after the surgery operation they are also responsible for monitoring and safety of the patient and the issue of accountability and legality arises on the activities or rather services they do in the operation theatre (Arfanis, Shillito & Smith 2011).
Therefore, it is clear that all the mentioned roles of the ASP require a professional and it is not all simple for them since the practitioners while in the operating theatre have to operate as the authentic registered nurses and they have impacted the surgical service on an extensive way. The ASP is a team of the surgical team and they are supposed to be responsible for their deeds within the operation theatre and for effective care delivery they ought to work amicably together with the surgical doctors towards meeting a universal goal of meeting the requirements and most importantly serving the sole interests of the patient. With accordance to the to the NMC policy of proficient contact, the fourth clause affirms that during the implementation of professional responsibility, the UK registered nurse have to, recognize any limits in their competence and knowledge and turn down any responsibilities or duties except if able to execute them in a secure and expert manner (Timpany, & McAleavy 2010).
The function of the ASP nurses during the instance of surgery has become the interested issue for the healthcare mangers since they are keen to make out what essentially happens at the rear of the closed theatre doors. It is important to recognize and elucidate the role of ASP from the viewpoint of legal subject since the role of the care professionals over the last decade has generally changed and predominantly the affected lot has been the nurses.
A practitioner is said to be an expert when he/she no longer depend on the guidelines and rules to connect their judgment and comprehending the circumstances so as to get the suitable action. Therefore, it must not be an issue for the Advanced Scrub Practitioners if they function from a profound and perceptive understanding of the entire situation in a surgical theatre since as a professional the practitioner ought to be proficiently qualified (Rao 2002).
The surgical service since the introduction of the post of Advanced Scrub Practitioner has changed largely towards the provision of the top notch operational services to the patients since the role of ASP is to ensure that the surgeon has ample environment while performing their surgery and more so taking care of the patient even after operation till they regain health. They supervise the surgical panel; support in crafting and guaranteeing a comfortable and more so a secure atmosphere for the patient (Epstein, & Hundert 2002).
The ASP practice is majorly influenced by pounding legal issues which the practitioner ought to be aware of, for instance like the subject of professional accountability and competency and therefore they have to be trained on the legalities of the profession. The speedy change and development of technology in the present world is quite an imperative factor and will have to be applied in the operating theatre. With the installation of the most modern and improved technology, then the overall impact of the ASP role to the operation department would be positively felt.
The obligation of care in the health service sector has become almost common term and therefore numerous medical practitioners are familiar with it. This aspect is basically applied in three specific areas namely; professional, legal, and employment issues, and all of them are interconnected for all the practitioners in the perioperative profession. The element of duty of care is actually owed by each and every healthcare expert and this phenomenon is present between an ASP and those people or rather clients/patients/ and relatives who may possibly be directly or indirectly affected by his/her actions or omissions. The common lawful obligation of care was characterized in a 1932 lawful suite of Donoghue v Stevenson. In this particular case, a consumer blamed a manufacturer for contaminating a beer bottle and the court ruled in favor of the claimant thus establishing the duty of care. The judge’s chief statement indicated that everyone has to administer logical care so as to evade omissions or activities which one can realistically predict to cause harm or injury to your neighbor.
There are many aspects which can be classified under the obligation of care where for instance a patient fails to heed the doctor’s prescription of medicine and he/she fails to do so, their health deteriorates then they have no chance to sue anyone since they are held responsible for their care. Another facet of responsibility of care is the one owed by an employer to the employed personnel and patients in a healthcare setting. The employer can be held responsible if they fail to make sure that their personnel is effectively trained and more so competent to deliver the type of care needed. In addition, they can accountable for breaching the duty of care if they do not provide the required safe systems within the care facility and if they fail to employ enough staff to take care of all patients. Therefore, in a health care setting, nearly anyone is liable to encompass an obligation of care ranging from the patient, personnel to even the employer. The job description of the Advanced Scrub Practitioner is at times not fully laid down since the post is new in U.K. and it has yet to be considered as a fully fledged occupation. Nonetheless, the ASP ought to know that their posts are very important in the operation department and duty of care should be observed at all times (Pirie 2012).
There are important elements found in the contract of service whereby the employer ought to stipulate clearly the roles and duties of a practitioner and more so competencies during the recruiting process. Nevertheless, other elements include protocols and policies whereby policies are described as the sketch of act assumed by the government, group or even a person while protocol is the plan which spells out procedures/measures to be dully followed. The above aspects clearly define the parameters of a position’s role and since the role of ASP is an extended one, and he/she has to stick to it so as to ensure full deliverance of the care services to the patients.
The Health Professions Council (HPC) which is the regulatory body behind the operating department practitioners came up with duties and roles for the ASP which basically stated that every practitioner is individually accountable for ensuring that he or she protects and promotes the best interests of the service users. The Nursing and Midwifery Council (NMC) which is the body responsible foor registering nurses stipulated that the patients in one’s care ought to be capable to truest him/her with their wellbeing and health. Therefore, so as to substantiate one’s trust, they should create the patient’s care to be their first concern, and more so respecting their decorum and care for them as human beings. The obligation of care in a healthcare setting is usually established between the Advanced Scrub Practitioner with the patient. The practitioner at all times ought to be responsive on the issue of responsibility of care towards the patients as its their duty to ensure that they offer the best care and standard of health care practice at all times. In the event of a court case, then the ASP will be solely viewed as the express or main responsible care provider to the patient.
Clinical competency is defined as the consistent and sensible application of values, emotions, reflection, clinical reasoning, technical skills, knowledge, and communication in daily healthcare practice for the full benefit of the patients and entire society being served up. Competency builds on top of footing of moral development, scientific knowledge, and most importantly basic medical skills and it comprises of a cognitive ability or function which involves attaining and usage of clinical and biomedical knowledge to resolve real-life troubles. The integrative function makes use of psychosocial and biomedical information in medical reasoning, while interpersonal skills and relational function enhances efficient communication with one’s colleagues and patients and more so professional qualities, moral/affective function which provides emotional awareness, patient, and willingness so that the practitioner employs all the skills acquired humanely and judiciously. Work competence is dependent on the behavior of mind together with presence, self awareness, critical curiosity, and attentiveness and clinical competency is context-dependent, impermanent, and developmental (Epstein & Hundert 2002).
Evidence-based practice has been on the use since the 1940s and it basically describes the process of analytically reviewing, evaluating and employing medical research results to help the deliverance of the best medical healthcare to patients. The Evidence-based practice is a segment of the comprehensive processes of guaranteeing clinical efficiency, and the major elements comprises of the creation of evidence via scientific review and research, distribution of evidence-founded medical guidelines, execution of evidence-founded, cost-effective healthcare practice through edification and administration of change, and the evaluation of conformity with approved practice regulation through medical audit and result-focused incentives. Therefore, basically, the Advanced Scrub Practitioner who possesses clinical competency and applies evidenced based medication to their patients has high chances of delivering maximum care to the patients since the skills acquired allows them to have the knowledge on how to modify treatment towards the conditions and the risk–benefit report of the specific patient (McQuay 2011).
The compilation of evidence founded medicine with competency forms the basis of a good practitioner and with the help of personal knowledge, they are able to quickly detect a certain patient’s demeanor and there and then through the diagnosis they are able administer the appropriate care. Therefore, individual knowledge is usually acquired through experience and ASP makes use of it every time in deducing the patient’s health issues and then going back to the exact information pertaining the issue. Clinical competence is generally comprised of integrative facets of care and a competent practitioner has incorporative ability to act, feel, and think like a medical doctor. Therefore, a competent ASP will possess the abilities to solve indistinct problems, endure uncertainty, and formulate decisions with partial information (Lee,, & Wimmers 2011).
Clinical competencies influences greatly on the type of patient care provided by the practitioner. Te more competence a clinical expert is , the higher the chances that he/she will administer top class care to a patient since they have an adequate skill and expertise on humanistic, clinical, and scientific judgment needed to take on clinical reasoning during care delivery. All these networks enable the practitioner to set off a practice of problem resolving from nominal information and employ successive information to improve their perception of the trouble. A competent clinician has the knowledge or rather skill on how to build therapeutic relations with the patients which normally affects the health and recuperation rate of the patients from illness. These skills makes the patients respond positively and faster towards care and therefore the general care delivery is improved due to the competency of the practitioner.
Lack of competency in clinical delivery has negative effects on the overall patient care since the practitioner possesses little basic knowledge on how to handle patients. Competency depends on the habits of one’s mind which allow them become self-aware, curious, attentive and more so willing to identify and correct mistakes but luck of these habits deem a practitioner unable to fully execute their duties in providing care to patients. Moreover, the disability to note that competency is generally context dependent on the task, clinical context, and surrounding of the specific health system makes one make wrong examination, and interpretation of a patient’s health issue thus offering the wrong healthcare. Competency is directly proportional to the level of healthcare provided therefore a more competent practitioner will definitely provide a superior patient care and vice versa (Choudhry, Fletcher & Soumerai 2005).
Risk appraisal is referred to as the process which facilitates organizations in understanding the variety of threats they face, intensity of capability to manage the risks, their probability of happening and their prospective impacts. If the budding risks are accurately assessed and controlled, then this can aid in setting all precedence for the healthcare delivery, individuals, and teams, and more so improve the decision-making framework to achieve a stability of risk, cost and benefit. The issue of improving the patient healthcare has really become a main concern for all care providers among the general purpose of achieving an elevated grade of patient contentment. The superiority of patient health care is fundamentally determined through the excellence of the facility’s infrastructure, the quality of education, the proficiency of human resources and effectiveness of the operational systems (Arfanis, Shillito & Smith 2011).
The management of risks in a healthcare facility is composed of overlying levels which include management/strategic level and the daily patient/staff operational level. Risk assessment and management in a hospital is composed of the entire range of effects that might and are capable of going wrong and they are arrived at through carrying out assessment. The assessment reveals things like falls, trips, slips involving the public, patients, and staff, managerial errors which affect on the patient care delivery and medical incidents which have a straight impact on the result of patient care. This initiative will also engulf the business treats linked with the operation of a hospice including information technology, ethical, and financial risks (Rao 2002).
Synergy (REF? AND NOT RELAVENT PARAGRAGH ) explains the contact of various elements found in a system in this case a healthcare facility so as to generate an effect dissimilar from or even better than the total of their character effects. Therefore, the concept of risk assessment in a hospice coupled with measures for an improved patient care can result in a superior outcome in that by the virtual of the two working together, each of them can benefit from the other as in the improvement of healthcare can utilize the information obtained from the risk assessment practice to better the entire system of patient care (Arfanis, Shillito & Smith 2011).
In conclusion, the Advanced Scrub Practitioner post in UK was introduced in the 1990s and at present she operates within a medical governance structure principally for the duration of the intra-operational period of a patients’ care. The role of an advanced scrub practitioner has been basically in the operation department were he/she is supposed to care for the surgical patients which includes offering expert support to the surgeon, organizing surgical environment, performing surgical procedures including dressings. However, the role components of ASP in hospital settings which have been discussed above provide an extensive insight of what patient care is at surgical settings and shows that how the patient care is always at the top of priorities and every practitioner has to put that in surgical nursing practice (Woodhead 2012).
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