How will you manage this situation? Provide reasons for your response
You are working with a plastic surgeon as the instrument nurse. Your patient is a young model who is having numerous skin lesions excised from her face and neck. Towards the end of the procedure, the surgical assistant is called away to see a patient in the emergency department. You are preparing for the count of instruments and needles with your circulating nurse. The surgeon asks if you are able to hold the skin hooks to retract the patient's skin. It is the final lesion to be excised and it is on the patient's cheek close to her eye.
What will be an ideal response?
Answer:
As instrument nurse, you are responsible for the count of instruments and needles with your circulating nurse and should not be interrupted in this process.
Assisting surgery is an advanced practice role. Retraction may be a role responsibility of the perioperative nurse surgeon's assistant and/or a nurse practitioner.
It may be appropriate for the instrument nurse to assist the surgeon in some situations; however, the specific nature of the assistance needs to be within the scope of practice of the nurses within that facility in general (and preferably documented in policy). In addition, the individual instrument nurse needs to be competent in the skill before agreeing to assist, otherwise should inform the surgeon that the skill is outside their individual scope of practice.
An untrained assistant may be increasing the risks to the patient, who in this case is a young model having plastic surgery to her face. These risks include skin and nerve damage as well as damage to her eye by a misplaced skin hook.
You have completed your first count and the surgeon is now preparing to suture two remaining incisions on the patient's face, including the incision near the eye.
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