Orthopaedic pre-admission assessment clinics: part I

Psychological preparation for patients undergoing day surgery

“…Moreover, many studies have emphasised the various aspects of psychosocial care and information provision required alongside modern surgical practices (French 1979, Reading 1982, Schoessler 1989, Yount and Schoessler 1991, Lonsdale and Hutchison 1991, Johnston et al 1992, Kratz 1993, Fareed 1994, Gould and Wilson-Barnett 1995, Goodman 1997, Motyka et al 1997, Bradshaw et al 1999, Fellowes et al 1999.…”

“…Duits et al (1999) argues group therapy and counselling is required in the pre-operative phase by the more neurotic patient but provides no indication as to what this involves or indeed the practical application of such a service. A report by the Royal College of Nursing and Society of Orthopaedic Nursing concerning patient pre-assessment (hospital appointment prior to the day of admission primarily to check medical fitness for surgery and anaesthesia) recommends psychological care should involve assessing coping with the demands of surgery (Fellowes et al 1999). However, the only suggestion put forward is to provide adequate information.…”

The emergence of specialist orthopaedic nurses and nurse-led pre-operative assessment in the 1990s

“…Pre-operative assessment (POA) clinics were designed to establish that a patient waiting for elective surgery still wanted to undergo the operation, still required it and was fit to undergo it as well as providing information to patients so that informed consent could be given (Fellows et al, 1998). Some early POA clinics were largely medically led with any nursing role being confined to the organisation of clinics and recording of observations.…”

Nursing knowledge and the expansion of day surgery in the United Kingdom

“…However, much of this work is dominated by medical protocols in order to guarantee medical fitness for surgery (22)(23)(24)(25)(26) . Although such tasks are vital, an unfortunate consequence of such a rapidly changing medical agenda is that evidence based 'nursing knowledge' has contributed very little to the success of day surgery (27) .…”

“…However, extended roles and the gaining of pre-assessment skills both embrace devolved medical tasks (23,26,38,(61)(62)(63)(64)(65) . Unfortunately, the exposition of nursing knowledge is again not considered although some studies have demonstrated the value of nursing skills in the pre-assessment clinic (39,66) .…”