Reflection 1

A CRITICAL REFLECTIVE PORTFOLIO OF EVIDENCE, DEMONSTRATING

SYNTHESIS AT THE THEORY-PRACTICE INTERFACE

By [Name]

Course

Professor’s name

Institution

Location of Institution

Date
 Reflection 2

Introduction

Having a role as a general surgical nurse, there are various roles that I am involved in

thus ensuring that quality care is adhered to. In a brief summary, as a general surgical nurse,

my key roles are related to provision of care to a surgical patient before, during, and after a

surgical procedure. Prior to any surgical procedures, my main roles revolve around the

patient, being involved in meeting with patients and their families in explaining to them the

procedures and the expectations including risks attached and the recovery time and further

their role in ensuring the safety of the patient. Among other crucial considerations involve

cleaning the cite of incision and further stitching the wound after the surgical procedure.

Monitoring and evaluating the patient after the procedure is also a crucial role involved thus a

need of professionalism and efficacy in ensuring that quality care is adhered to. Among the

key experiences as a general surgical nurse are associated to issues and challenges that I

experience on a daily basis some attached to the pressure involved in the provision of care to

these patients. Time and patience is a crucial aspect in this profession and given the relevance

of quality, it is considered crucial to acknowledge some of the challenges experienced. One

of the key issues is based on errors where considering the complexity of presurgical aspects

such as documentation, I value the relevance of checklists and consistency in communication

before the surgical procedures. Additionally, teamwork is also an aspect that has an impact

where working under minimum supervision, I consider it relevant to be maximally

responsible in ensuring that everything is crosschecked thus minimising errors. The essay

focuses on addressing some of the key challenges and issues experienced and further

documented by researchers in relation to general surgical nurses. Additionally, the essay

focuses on addressing the significance of checklists specifically focusing on the WHO

surgical safety checklist and its efficacy in minimizing issues such as deaths and errors in

surgical patients.
 Reflection 3

Roles, Challenges, And How to Effectively Care for Surgical Patients

From a personal experience, nurses have a significant role in promoting the health of

patients. Research has also been played a considerable role in understanding the role that

nurses have in ensuring that surgical patients experience a satisfactory care. This can be noted

from a study by Nestler (2016), where the author stated that based on the importance of

nurses in providing care for surgical patients, it should be noted that they always

continuously work in very close contact with patients thus fostering the realization of

activities of daily living as well as ensuring quality medical treatment. This means a high

educational level and high commitment to these patients. Among the key considerations that

Nestler (2016) and further noted from a study by Aglio et al. (2022) noted is that through

primary contact with surgical patients, nurses always assess the competencies in the daily

living and activities of the patient before and after surgery, participating in the evaluation of

needs for assistance to the patient. This ensures a smoother transition of the patient to normal

daily lifestyle. Another considerable role that has efficacy and necessitated by research is

based on communication.

One of the key roles that has always been necessitated along my practice focuses on

constant and consistent communication that is timely to relevant practitioners in care

provision to surgical patients. A study by Flynn et al. (2022) commented on this stating that

in care coordination to surgical patients, nurses are always the first to communicate with the

physician and other occupational groups in the planning for treatment process for surgical

patients. Udelsman et al. (2019) further in their study of clinician-to-clinician communication

on patient goals related to surgical patient outlined that during care planning, nurses have a

relevance in coordinating key communications between these coordinating groups in enabling

a smooth care provision to the patient. As per the authors, in addressing barriers including

record inaccessibility, lack of protocols, and difficulties attached to the documentation of

complex conversations, nurses are always the most influential coordinators ensuring that each

barrier is addressed sufficiently. This leads to the acknowledgement of the role of nurses in

providing clear and understandable communication and records to physicians and other

occupational groups as in poor coordinated care, then failure in coordinating the care is

always blamed to the nurse given inefficiency in practice. Another considerable role is

associated with patient education.

Researchers such as Kang et al. (2020) and Kang et al. (2018) in their studies

necessitated the role of a nurse in ensuring that patients gain sufficient knowledge on self-

care and self-management of patients after a surgery in a bid to ensure sufficient knowledge

in transitioning from dependency of care to self-dependence in management of surgical

wounds. This is a procedure that based on personal experience, it was always necessary to

ensure that a patient has a smooth and effective care transition from depending on basic care

provided by a nurse to self and family-based care provision. As per Kang et al. (2018), in

postoperative general surgery patients, this is a period where postoperative complications

occur mainly during the first 30 days after an operation. The authors in combination to

findings from a study by Kang et al. (2020, p.1698) stated that nurses have an advanced role

with Kang et al. (2020, p.1698) stating that nurses have four key roles in this process

including “assuming responsibility for patient education in the absence of discharge

communication; supporting patients to participate in self-management after hospitalization;

variability in the resources, content and delivery of discharge education.” As such, it is

crucial for nurses to consider these key concepts among other relevant aspects in the delivery

of patients thus ensuring a smooth transition.

Despite the significances of nurses in surgical care, it is also prudent to consider that

given that there is not always an effective care considering patient differences and

environmental effects in maintaining an effective care to these patients. Resaei et al. (2018)
 Reflection 5

acknowledged that it is also always challenging for nurses in providing sufficient care to

surgical patients which in most cases leads to gaps in the care produced. Rezaei et al. (2018)

noted that the most considerable gaps include quality evaluation, medication management,

surgery assistance, and other major operations attached to this process. A study by Neville

and Roan (2014) noted that one of the key challenges is also always attached to caring for

surgical patients with substance abuse dependence. In a personal experience, most of surgical

patients especially those with long-term use of drugs and struggle with addition issues. This

has been confirmed by various researchers including: Hasak et al. (2018) a study on

empowering post-surgical patients to improve the disposal of opioids in post-surgery; Straw

et al. (2020) noting the implications to patients fighting drug addiction and the effects of

clinical infection diseases attached to post-surgery; and Eamer et al. (2018) in their study

focusing on morbidity and mortality attached to elderly surgical patients, drug abuse being

among them; among other studies noting the impacts of this issue not only on health

outcomes but also the provision of care. Focusing on the autonomy of a patient, it is always

challenging to address this issue in surgical patients who are drug addicts. In their study,

Naville and Roan (2014) stated that nurses in such circumstances need additional educational

and professional support in care provision to these patients.

Lastly, based on the acknowledgement of these key crucial issues associated to

nursing care for surgical patients, there are further additional professional needs that need to

be addresses. As noted in the previous analysis based on the key roles in my experience and

further supported by different researchers, nurses not only experience challenges but they

have an important role in ensuring that surgical patients experience sufficient care that is

attached to their care needs and further must always act professionally. We as nurses have an

extensive role in not only bridging care provided to a surgical patient through sufficient

succinct and dependable and timely communication but also ensure that patients have a
 Reflection 6

smooth time transitioning from care provided to self-management. It is also relevant for us to

consider the impacts we have as nurses in ensuring that surgical patients adhere to care and

have a normal lifestyle in post-surgical life compared to their previous lifestyle with

consideration of professional needs as can be noted from the next sections.

WHO Surgical Safety Checklist

From the previous analysis, it was noted that among the main roles that nurses have is

bridging effective communication in managing surgery patients through effective practices

attached to not only handover but also coordination of care of these patients thus

communicating sufficiently with the physician and other occupational groups. This is an issue

that has always been of concern and also noted to have significant implication in patient

safety care provision. As of a study by Haugen et al. (2019), the WHO safety checklist is

among the tools that was developed through the consideration of complications that are

attached to surgical procedures mainly pore-surgical procedures hence eliminating issues that

might put the safety of the patient at a risk.

On the relevance of the WHO checklist, in a study by Jain et al. (2016) on answering

the main question on why we need the WHO safety checklist stated that majority of adverse

events, the authors approximating it to approximately 43%, happen in the operating theatre.

Additionally, in a study by Shankar (2018), an approximate of 234 million people undergo

major surgery and of these population, more than one million of these patients die due to

complications that Jian et al. (2016) noted are avoidable. Regardless, of the issues attached to

surgical procedures, it is relevant to note that surgical safety as acknowledged by Jian et al.

(2016) has not yet been recognized as a health problem due to resources especially in middle-

and low-income countries. As such, authors such as Hadia et al. (2021) among other authors

necessitated the relevance of implementing and utilising the WHO surgical safety checklist in

routing practice thus ensuring the adherence to various issues including teams adhering to
 Reflection 7

critical safety steps, consistency in ensuring patient safety steps, and the maintenance of a

culture of teamwork and safety.

As noted in the previous section and further in the introductory phase of this section,

communication is among the most considerate aspect that is focused on with nurses ensuring

that they play a central role in ensuring no mishaps encountered along the communication

and implementation of the care plan for these patients. As per a study by Bukoh and Siah

(2020), among the key challenges encountered that is affiliated to communication and patient

safety is attached to handover with the authors noting that the key challenges attached to this

issues include information inaccuracy, omission of information, and documentation errors.

This in most instances is attached to the previously outlined challenges experienced by

surgical patients in surgical wards thus leading to deaths that were preventable. As such,

through the consideration of the WHO checklist, it is possible for nurses to ensure an

effective communication. As per a study by Walker et al. (2012), the relevance of the WHO

surgical safety checklist is unmatched with nurses being recommended to consider it

significance in addressing issues attached to the safety of the patient thus utilized in the

reduction of errors involved in documentation among others.

Generally, the WHO safety checklist has been considered the most effective in

addressing some of the key challenges that are experienced by not only nurses but also

physicians and other healthcare professionals involved in the coordination of care and

surgical procedures thus promoting an effective coordinated care with sufficient and

dependable communication. This in turn promotes the quality of care experienced by a

surgical patient.

Efficacy Of WHO Surgical Safety Checklist

Based on the effectiveness of the WHO surgical checklist, as previously noted and

outlined, it is relevant for healthcare practitioners, precisely focusing on nurses given that the
 Reflection 8

first source of error is always associated with this phase of care to consider the relevance of

the implementation and utilization of the surgical safety checklist.

From a study by Jian et al. (2018), since the WHO safety checklist was incepted in

healthcare in 2008, there have been various studies pilot studies globally, the authors

accounting these studies to 8 stating that there have been various steps noted since the

checklist was implemented in the hospitals. As per Jian et al. (2018), the rate of site

infections due to surgical procedures significantly decreased to 3.4 percent from 6.2 percent

which accounts for a decrease of up to half. Additionally, as per the authors, based on death

rates which was among the key focus when implementing the checklist, there was a notable

decrease to 0.8 percent of deaths from the previous 1.5 percent. This means a significant step

has been improved in the background thus promoting the efficacy of healthcare practitioners.

Focusing on the efficacy of the WHO surgical safety checklist, it is also relevant to

focus on the applicability and ease in addressing some of the key challenges that are attached

to surgical procedures from pre-surgery to post-surgery. From a study by Cabral et al. (2016),

the authors noted that since the implementation of the WHO safety checklist back in 2008,

different practitioners involved in a survey noted that there are various milestones noted in

their interaction and utilization of the checklist. As per the author, based on the usability of

the checklist, 79 percent of the staff noted that the checklist was easier to use. Additionally, it

is also relevant to focus on the aspect attached to the improvision of care and the perception

of care providers. White et al. (2020) commented in this aspect noting that an approximate of

79 percent of staff considered its relevant in the simplification of tasks thus enabling

improvised care. To these participants, since the implementation and trial of the surgical

safety checklist, they noted an improvement in care. Another most crucially is addressing the

challenge attached to communication. As per a study by Cullati et al. (2013) as per then, the

surgical safety checklist was considered to be more effective when utilized rather than when
 Reflection 9

not used. As per Jian et al. (2018) the efficacy attached to the utilization of the WHO safety

checklist in addressing the challenge of communication was approximated to be 84 percent.

Lastly, based on errors, Jian et al. (2018) also noted that 78 percent thought the checklist to

be an effective aspect in error reduction. This proves the efficacy of the checklist in

addressing the most significant issues that are attached to surgical procedures.

Regardless, in the implementation, for accuracy purposes, it is also relevant to address

some of the key challenges that are attached to the implementation of the surgical safety

checklist. From a study by Haugen et al. (2019), some of the barriers that are attached to the

WHO’s surgical safety checklist as outlined by the authors include inefficacy of the checklist

in increasing operation time, first starts on time, or same day cancellations. Additionally,

Verwey and Gopalan (2018) further noted the key barriers are related to time issues and lack

of buy-in from team members. Their study mainly centered at confirming the barriers given

that there were no new barriers that were experienced along their study. Regardless, all these

authors commented on the relevance of the WHO surgical safety checklist. As per the

authors, the checklist was much more relevant in the current healthcare setting given its

implication in addressing key issues attached to mortality rates and strategic directions in

error reduction. All the authors confirmed its relevance in the implementation of the checklist

thus recommended for nurses to always consider its efficacy and utilize it maximumly and

sufficiently when dealing with surgical patients. Regardless of the comments and further

clarifications, it has also been noted as per a study by Haugen et al. (2019) that the checklist

has not always been implemented effectively with the author recommending for a more

advanced mechanism to be used in the implementation thus enabling sufficient utilization.

How to avoid errors

As per a study by Rodziewics et al. (2022), the authors stated that the best way in

making sure that errors are reduced in surgery is pausing before the surgery and double
 Reflection 10

checking. As previously outlined and further acknowledged by the author, among the key

errors that are experienced in surgery among other healthcare practices in the hospital, mainly

related to nurses include errors of omission which are mainly resulted by actions not being

taken; and errors of commission which are errors done when a practitioner is involved in

taking a wrong action. Regardless, there are various strategies that have been considered

effective in such instances especially in surgical procedures that have always been associated

to complications.

As stated before, during surgery, there are various aspects that may lead to errors that

may not be effective in addressing the safety of the patient. As such, Rodziewics et al. (2022)

in their study first focused on the aspect of croisscheckin and ensuring that every aspect if

correct. As per the authors, preventing a mistake in surgery is mainly associated with the

prevention of doing the wrong surgery on the wrong patient and in some instances at the

wrong body part.

Another significant implication that has been severally documented has been attached

to the issue of communication. It can be noted even on the previous paragraph that through

the errors associated with communication, the wrong patient might receive the wrong surgical

procedure. As such, Fudickar et al. (2012) in their study focusing on the relevance of the

WHO surgical safety checklist commented on the issue of communication. The authoers

noted that it is relevant or practitioners to always consider the implications of ineffective

communication. As per Fudickar et al. (2012) it is always relevant to consider that the

checklist is done sufficiently. Additionally, the authors commented on the relevance of

briefing. To the authors, this is a team meeting where information needed for the joint

performance of task is exchanged and checked. Through briefing, nurses among other

specialists involved in the teamwork will have sufficient knowledge on what proceeds thus

minimizing errors that might have occurred.

Generally, considering some of the outlined safety measures that might be considered

in the minimization of errors, it is also crucial to utilize the WHO surgical safety checklist in

surgical procedures given that it minimizes the chances of encountering any errors along the

procedure. This should be followed by cross checking that each aspect has been addressed

before any briefing. As such, errors will be significantly reduced hence ensuring that quality

has been adhered to.

Conclusion

Generally, the research mainly focused on a reflection on surgical practices with a

target in addressing the role that nurses have in relation to surgical patients and examine the

contemporary issues and challenges associated with surgical care. From the analysis, based

on the roles and challenges that nurses experience in provision of care to surgical patients, it

was noted that among the key roles nurses are involved in are attached to their first

interaction with the patient. It was outlined that nurses in surgical care have a role to

communicate sufficiently to the physician and other practitioners involved in teamwork in

ensuring the patient receives quality care. From the analysis, it was also noted that during the

care for surgical patients, there are various issues and challenges that nurses among other

practitioners’ experience. The first and most crucial aspect is related to communication. Due

to the implications of communication, there are various issues that may be experienced

including surgery being performed on the wrong patient or on the wrong body part. This has

more damages to the quality of care provided to the patient. Another significant issues that is

also associated to communication is the aspect of errors that are associated to communication.

Among the most common errors outlined include errors of omission, inaccuracy of

information, and errors associated to documentation. This is an error that occurs at the first

site in care provision before handout thus necessitating the relevance of nurses in ensuring

effective practices along their documentation and record keeping. among other errors are
 Reflection 12

based on the surgical procedures. Due to such issues, the WHO developed the surgical safety

checklist that focused on addressing the key issues involved in the documentation and

procedures along the surgery. From the research conducted, it was noted that the surgical

checklist, having been implemented in 2008, has been more effective in addressing key issues

such as deaths associated with surgery that have been noted to have been more before the

implementation. Additionally, the checklist has been proven to be more effective in error

reduction thus minimizing the percentage of errors involved in surgical procedures. Most

healthcare practitioners and nurses have implemented and commented on the relevance of the

implementation of the WHO surgical safety checklist thus enabling them minimize errors

along their practices. It was also relevant to consider the analysis on hoe to minimize errors

along the care provision to surgical patients. Among the key aspects considered was an

effective communication that focused on documentation which it was recommended for

nurses and practitioners to always consider cross checking and double checking that every

aspect was addressed. Additionally, in significantly minimizing errors, it was recommended

for healthcare practitioners to always consider the relevance of briefing as this not only

minimizes errors but also promotes the effectiveness so team work involved in the surgical

procedure.
 Reflection 13

References

Aglio, L.S., Mezzalira, E., Mendez-Pino, L., Corey, S.M., Fields, K.G., Abbakar, R., Baez,

L.A., Kelly-Aglio, N.J., Vetter, T., Jamison, R.N. and Edwards, R.R., 2022. Surgical

Prehabilitation: Strategies and Psychological Intervention to Reduce Postoperative

Pain and Opioid Use. Anesthesia & Analgesia, 134(5), pp.1106-1111.

Bukoh, M.X. and Siah, C.J.R., 2020. A systematic review on the structured handover

interventions between nurses in improving patient safety outcomes. Journal of

nursing management, 28(3), pp.744-755.

Cabral, R.A., Eggenberger, T., Keller, K., Gallison, B.S. and Newman, D., 2016. Use of a

surgical safety checklist to improve team communication. AORN journal, 104(3),

pp.206-216.

Cullati, S., Le Du, S., Raë, A.C., Micallef, M., Khabiri, E., Ourahmoune, A., Boireaux, A.,

Licker, M. and Chopard, P., 2013. Is the Surgical Safety Checklist successfully

conducted? An observational study of social interactions in the operating rooms of a

tertiary hospital. BMJ quality & safety, 22(8), pp.639-646.

Eamer, G., Al-Amoodi, M.J., Holroyd-Leduc, J., Rolfson, D.B., Warkentin, L.M. and

Khadaroo, R.G., 2018. Review of risk assessment tools to predict morbidity and

mortality in elderly surgical patients. The American Journal of Surgery, 216(3),

pp.585-594.

Flynn, D.E., Flynn, H., Gifford, S. and Smith, K., 2022. Can you hear me? Analysis of a

Queensland patient‐initiated escalation process and the importance of communication

in surgical care. ANZ Journal of Surgery.

Fudickar, A., Hörle, K., Wiltfang, J. and Bein, B., 2012. The effect of the WHO Surgical

Safety Checklist on complication rate and communication. Deutsches Ärzteblatt

International, 109(42), p.695.
 Reflection 14

Hadia, R., Joseph, J.J., Mathew, J., Patel, S., Rathod, T., Joshi, D., Shah, B., Baile, S., Gohel,

K., Kardani, S. and Maheshwari, R., 2021. Implementation of WHO Surgical Safety

Checklist and Pre-operative Anxiety Levels to Study the Effect on Post-operative

Recovery among Surgery Patients.

Hasak, J.M., Bettlach, C.L.R., Santosa, K.B., Larson, E.L., Stroud, J. and Mackinnon, S.E.,

2018. Empowering post-surgical patients to improve opioid disposal: a before and

after quality improvement study. Journal of the American College of

Surgeons, 226(3), pp.235-240.

Haugen, A.S., Sevdalis, N. and Søfteland, E., 2019. Impact of the world health organization

surgical safety checklist on patient safety. Anesthesiology, 131(2), pp.420-425.

Jain, D., Sharma, R. and Reddy, S., 2018. WHO safe surgery checklist: Barriers to universal

acceptance. Journal of anaesthesiology, clinical pharmacology, 34(1), p.7.

Kang, E., Gillespie, B.M., Tobiano, G. and Chaboyer, W., 2018. Discharge education

delivered to general surgical patients in their management of recovery post discharge:

a systematic mixed studies review. International journal of nursing studies, 87, pp.1-

13.

Kang, E., Tobiano, G.A., Chaboyer, W. and Gillespie, B.M., 2020. Nurses' role in delivering

discharge education to general surgical patients: a qualitative study. Journal of

advanced nursing, 76(7), pp.1698-1707.

Nestler, N., 2019. Nursing care and outcome in surgical patients–why do we have to

care?. Innovative surgical sciences, 4(4), pp.139-143.

Neville, K. and Roan, N., 2014. Challenges in nursing practice. The journal of nursing

administration, 44(6), pp.339-346.

Rezaei, T., Ghahramanian, A., Abdullahzaed, F., Sheikhalipour, Z., Asghari-Jafarabadi, M.

and Fadaei, Z., 2018. Service quality gaps in the provision of care to surgical patients:
 Reflection 15

a cross-sectional study in the northwest of Iran. Journal of Caring Sciences, 7(3),

p.157.

Rodziewicz, T.L., Houseman, B. and Hipskind, J.E., 2022. Medical error reduction and

prevention. StatPearls [Internet].

Shankar, R., 2018. Implementation of the WHO Surgical Safety Checklist at a teaching

hospital in India and evaluation of the effects on perioperative complications. The

International journal of health planning and management, 33(4), pp.836-846.

Straw, S., Baig, M.W., Gillott, R., Wu, J., Witte, K.K., O’regan, D.J. and Sandoe, J.A., 2020.

Long-term outcomes are poor in intravenous drug users following infective

endocarditis, even after surgery. Clinical Infectious Diseases, 71(3), pp.564-571.

Udelsman, B.V., Lee, K.C., Traeger, L.N., Lillemoe, K.D., Chang, D.C. and Cooper, Z.,

2019. Clinician-to-clinician communication of patient goals of care within a surgical

intensive care unit. Journal of Surgical Research, 240, pp.80-88.

Verwey, S. and Gopalan, P.D., 2018. An investigation of barriers to the use of the World

Health Organization Surgical Safety Checklist in theatres. South African Medical

Journal, 108(4), pp.336-341.

Walker, I.A., Reshamwalla, S. and Wilson, I.H., 2012. Surgical safety checklists: do they

improve outcomes?. British journal of anaesthesia, 109(1), pp.47-54.

White, M.C., Daya, L., Karel, F.K.B., White, G., Abid, S., Fitzgerald, A., Mballa, G.A.E.,

Sevdalis, N. and Leather, A.J., 2020. Using the knowledge to action framework to

describe a nationwide implementation of the WHO surgical safety checklist in

Cameroon. Anesthesia and analgesia, 130(5), p.1425.