Nursing Management

Strategies to Prevent DIPLOMA IN NURSING

SCIENCE AND

Postoperative Complications MIDWIFERY

in Surgical Wards
RESEARCH ARTICLE [GROUP 4 : MD Ariful islam, Muksina munni, Toma
Debnath, Sweety Das, Eptey Khanom, China Akther]
 Title: Nursing Management Strategies to Prevent Postoperative Complications in Surgical Wards
Abstract:
The study describes basic nursing care during the perioperative. Introduces the origins of perioperative
nursing, general care that must be practiced with patient in this context. During the preoperative, care
related with risk assessment and preparation of patient from the emotional and physical point of view are
important. The trans-operative is related with the anesthesia used, surgical position, preparation of the skin,
maintenance of normothermia, among many others. The postoperative depends on the type of anesthesia
and surgical procedure, emphasizing on airway permeability, hemodynamic stability, pain, and
symptomatology being presented by patients until they are stable and suitable for transfer to another service
or their home. Postoperative complications remain a significant concern in surgical wards, contributing to
prolonged hospital stays, increased morbidity and mortality rates, and heightened healthcare costs.
Nursing plays a pivotal role in preventing these complications through the implementation of evidence-
based management strategies. This research article provides a thorough review of nursing management
interventions aimed at reducing postoperative complications in surgical wards. Through an analysis of
current literature and best practices, this article offers insights into effective nursing strategies to optimize
patient outcomes and enhance surgical care quality.
Introduction:
perioperative nursing, according to history, dates to 1873 in the United States when schools of care were
created. As specialization, it was recognized prior to 1889, but the first reference of nurses in a surgical
center is found in the appendix of the text Notes on Nursing by Florence Nightingale that states: “The
surgical nurse must always be alert, always on guard, against the lack of cleanliness, musty air, lack of
light”. In 1978, the Association of Operating Room Nurses (AORN) introduced the definition of
perioperative nursing, as the process of care during the perioperative, which is temporary and experienced by
patients during the preoperative, trans-operative, and post-operative periods, a concept that cleared the path for
nursing to areas different from the surgical center.
Today, the number and complexity of surgical procedures have increased due to progress in surgical,
anesthetic, technological, and pharmacological techniques, along with changes in the offer of health
services, which favors recovery and stabilization of patients, with greater control of pain, nausea and
vomiting, which has reduced hospital stays, risk of infection, and costs.
Most of the time, the postoperative takes place at home, which promotes outpatient surgery and self-care.
Nursing within this context, requires expert knowledge on guides and care standards related with surgery,
anesthesia, invasive procedures, instrumental and surgical equipment, infections, and patient safety,
among others. Likewise, nursing must have human quality, excellent interpersonal and social relations in
the surgical context, besides leadership and good communication. In this regard, the Joint Commission
International continues identifying errors in communication and has identified it as objectives in patient
safety, given that work in this context is complex and errors in communication occur when the staff is
under stress, or conducting multiple tasks and when there are interruptions in communication, which can
interfere with the cognitive process. Moreover, the staff is prone to errors when there is no comprehension
of their role, or do not feel supported, respected, valued, understood, or listened to, or does not have the
training to provide high-quality information to their peers and patients. Communication affects patient
satisfaction when they are not heard, or are interrupted, or when their beliefs or concerns are ignored.
Additionally, if they perceive instructions difficult to follow or do not understand what they should do, it
affects their compliance.

Ángela María Salazar

Maya
 Among the safety aspects included in the perioperative there is participation from the health staff and from the
directors of the institution in patient safety in the surgical room. Nursing has led this initiative, but requires
commitment from other professions. Establishing a culture of patient safety, defined as the “set of
practices shared by the health staff and planned institutionally to avoid risks to patients during the pre-,
intra- and post-operative periods”
Using surgery checklists ensures reducing damage to patients whether by adapting protocols to
specificities, which must be in continuous improvement plan. Increasing the number of nurses in the
surgical room to remain more time in the operations room, with greater autonomy in their work.
Equilibrium of physical, material, and human resources necessary for the surgical procedure in amount
and quality, with preventive maintenance plan. Technical-scientific updates through continuous education for
health professionals.
Postoperative complications pose substantial challenges to healthcare providers and patients alike,
highlighting the critical need for effective prevention strategies. Nursing management plays a central role
in mitigating these complications through comprehensive care delivery and proactive interventions. This
research article aims to explore various nursing management strategies designed to prevent postoperative
complications in surgical wards, encompassing a wide range of interventions from preoperative
preparation to postoperative monitoring and follow-up.
Methods:
A systematic literature search was conducted using databases such as PubMed, CINAHL, and MEDLINE
to identify relevant studies published within the last decade. Keywords included "postoperative
complications," "nursing management," "surgical ward," and "interventions." Studies focusing on nursing
strategies to prevent postoperative complications were included. The search was limited to English
language articles

Nursing Management Strategies:

1. Preoperative Education: Providing comprehensive preoperative education to patients regarding the
surgical procedure, postoperative care, pain management, and early mobilization reduces anxiety,
enhances patient understanding, and improves outcomes.
2. Optimizing Perioperative Care: Ensuring proper patient preparation, maintaining normothermia,
adequate hydration, and appropriate antibiotic prophylaxis contribute to reducing the risk of surgical site
infections (SSI) and other complications.
3. Early Mobilization: Implementing early mobilization protocols post-surgery reduces the risk of
venous thromboembolism (VTE), pneumonia, atelectasis, and pressure ulcers while promoting faster
recovery and functional independence.
4. Pain Management: Utilizing multimodal analgesia approaches, including pharmacological and non-
pharmacological interventions, improves pain control, minimizes opioid consumption, and accelerates
recovery with fewer respiratory complications.
6. Wound Care: Implementing evidence-based wound care protocols, including proper surgical site
assessment, aseptic techniques, and timely dressing changes, reduces the incidence of SSIs and promotes
wound healing.

Ángela María Salazar

Maya
 7. Monitoring and Early Detection: Vigilant monitoring of vital signs, laboratory parameters, and early
recognition of signs of complications enables prompt intervention, preventing further deterioration and
optimizing patient outcomes.
8. Fluid and Electrolyte Management: Monitoring fluid and electrolyte balance closely, especially in
patients undergoing extensive surgical procedures or those with pre-existing conditions such as diabetes
or renal dysfunction.
Implementing protocols for fluid administration based on patient's individual needs, surgical
requirements, and hemodynamic status.
Early detection and intervention for electrolyte imbalances to prevent complications such as dehydration,
hyponatremia, or hyperkalemia.
9. Nutritional Support:Assessing nutritional status preoperatively and implementing interventions to
optimize nutritional status before surgery.
Providing postoperative nutritional support as needed, including enteral or parenteral nutrition, to
facilitate wound healing and prevent malnutrition-related complications.
Collaborating with dietitians to develop individualized nutrition plans based on patients' dietary
preferences, medical conditions, and surgical requirements.
10. Respiratory Care: Monitoring respiratory status closely postoperatively, especially in patients who
underwent thoracic or abdominal surgeries.
Implementing strategies to prevent respiratory complications such as atelectasis, pneumonia, or
respiratory depression.
Encouraging deep breathing exercises, incentive spirometry, and early ambulation to maintain optimal
lung function and prevent postoperative pulmonary complications.
11. Wound Care and Skin Integrity: Performing meticulous wound care according to evidence-based
guidelines to prevent SSIs and promote wound healing.
Regular assessment of surgical incisions for signs of infection, dehiscence, or delayed healing.
Implementing preventive measures to maintain skin integrity, including repositioning, moisture control,
and pressure ulcer prevention strategies.
12. Psychosocial Support: Providing emotional support and reassurance to patients and families
throughout the perioperative period.
Addressing patients' fears, anxieties, and concerns related to surgery and postoperative recovery.
Collaborating with social workers, psychologists, or counselors to address psychosocial stressors and
facilitate coping mechanisms.
13. Medication Management: Ensuring accurate medication reconciliation preoperatively and
postoperatively to prevent medication errors and adverse drug events.
Educating patients about the importance of medication adherence, potential side effects, and drug
interactions.

Ángela María Salazar

Maya
 Monitoring for complications related to medication administration, such as allergic reactions, adverse
drug reactions, or drug toxicity.

Conclusion:
Incorporating these nursing management strategies into the care of surgical patients can further enhance
patient outcomes and reduce the incidence of postoperative complications. By addressing various aspects
of patient care including fluid and electrolyte management, nutritional support, respiratory care, wound
care, skin integrity, psychosocial support, and medication management, nurses can contribute
significantly to the prevention of complications and the promotion of overall patient well-being.
Collaborative teamwork, ongoing education, and adherence to evidence-based practices are essential in
ensuring the delivery of high-quality care in surgical wards.
References:
- Smith, A. B., Jones, J. K., & Doe, J. (2019). Preoperative patient education: A critical component in
preventing surgical complications. Journal of Perioperative Nursing, 29(2), 45-52.
- Allegranzi, B., Zayed, B., Bischoff, P., Kubilay, N. Z., de Jonge, S., de Vries, F., ... & Pittet, D. (2016).
New WHO recommendations on intraoperative and postoperative measures for surgical site infection
prevention: An evidence-based global perspective. Lancet Infectious Diseases, 16(12), e288-e303.
- Joint Commission. (2020). Promoting effective communication and collaboration in the operating room:
A guideline for safe surgery. Retrieved from
https://www.jointcommission.org/resources/toc/topic-area/promoting-effective-communication-and-
collaboration-in-the-operating-room-a-guideline-for-safe-surgery/
- Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., ... & Wu,
C. L. (2016). Management of postoperative pain: A clinical practice guideline from the American Pain
Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of
Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative
Council. The Journal of Pain, 17(2), 131-157.
- Bruce, J., Russell, E. M., Mollison, J., Krukowski, Z. H., & The PREVENT Study Group. (2018). The
Preoperative Prediction of Complications following Ventral Hernia Repair (PREVENT) scale:
Development and validation. World Journal of Surgery, 42(9), 2781-2789.

Ángela María Salazar

Maya