Concept Analysis of Surgery

 

Naming of the concept

Identification and isolation of the concept

            A wide range of interventions are usually used to treat patients in the health care, one of it is surgical intervention.  Surgical interventions are usually employed in cases where it is necessary to improve the health of the patient and also facilitate recovery from other conditions.  Provision of high quality care is important to facilitate recovery from surgery and also to meet the needs of the patient (Perdue et al., 2018).  The practice of surgery has become common in healthcare and it can be done to serve different functions such as explorative, diagnostic and curative.

Dictionary and thesaurus definition

                According to by Merriam-Webster (2018), the term surgery is “a branch of medicine concerned with diseases and conditions requiring or amenable to operative or manual procedures”.  Surgery is further defined as the actual performance of procedures by surgeons.  The word surgery may describe a place where an individual trained in surgery practices or in British English as a physician or dentist office.  Additionally, surgery is a special period of time; during this time period constituents may visit their representative in British Parliament to seek consultation (by Merriam-Webster, 2018)

Critical attributes

            Concept analysis needs determination of the critical attributes of the characteristic that are mostly frequently associated with the concept and shows up on reference to it (Walker & Avant, 2011).  Based on this, the critical attributes that were identified for surgery are:

• Invasive in nature – all procedures even so-called non-invasive surgery enters tissue at some point and this entry remains invasive.
• Tissue damage- physical alteration in some form will always occur with surgery.
• Permission- some form of consent or approval will always occur. This permission may be provided from the individual, the family or caretaker in the instance of veterinary surgery.  Even in the instance of emergency surgery a two-provider consent is obtained therefore permission is always a requirement.

Background for the Concept

Literature Review

            The first recorded evidence of surgery was in the practice of cranial opening called trephining.  The practice was widely performed in the early ages and it proceeded to the middle age and later to renaissance (Castiglioni, 2018).  The practice of cranial opening was performed in Europe, South America and in Africa and it is not clear why it was done but it has been claimed to get rid of body spirits.  However, the origin of the practice is not certain.  The people of South America also practiced dental surgery where teeth which had cavities were filled with precious stones for the purpose of demonstrating ritual adherence in spiritual practice.  Additionally, bloodletting was also practiced in Egypt and ancient Greek with believe that it would treat variety of disease states (Lawrence, 2018).  Bloodletting was a form of surgery which tried to enter into the vascular system to facilitate removal of blood considered impure.         In the middle ages and renaissance, barbers and their cutting instruments were surgeons and would travel to perform minor surgeries which included extraction of teeth, treating injury and bloodletting.  Surgery was learned through observation and result with little ability to prevent sepsis or reduce pain.  Interestingly women often practiced surgery until 1700s when studies on surgery began to be offered at universities where women were excluded (Lawrence, 2018).  Andreas Vesalius is considered a founding father of modern surgery.  His focus on understanding human anatomy, through human dissection led to major advancements in the practice of surgery.  His observations recorded in De Humani Corporis Fabrica Libri Septem corrected many erroneous misconceptions held as far back as the Greek and Roman Empire (Lawrence, 2018).

            In the 16th century, Ambrose Pare influenced the development of surgery when he came up with rose oil, emollient of egg yolk and turpentine for gunshots which were better than cauterizing.  Ambrose developed the practice of legation of blood vessels to reducing blood loss during the practice of surgery.

            Not until the advent anesthesia in the late 1800s was it possible to perform complex internal surgery and amputation was the most advanced curative surgical procedure.  In 1865, Joseph Lister developed the concept of microorganisms causing pathology of sepsis and disease.  Lister as a result of his understanding of this this related concept then developed the concept of sterilization of instruments utilizing carbolic acid.  By the 20th century, the practice of asepsis and sterilization became standard practice and greatly advanced the practice of surgery (Castiglioni, 2018).

Concept with Antecedents, Cases, and Consequences

Antecedents

The concept of surgery antecedents are the presence of surgical instrument/equipment and some form of tissue disturbance.  Surgical instrument/equipment is needed to aid in performance of surgery as there is no realistic way to incise or open tissues without the aid of an instrument.  Some form of tissue disturbance must exist, it can be further categorized as one of the following disturbances 1.)  Injury (wound) 2.)  Pathology (disease) or 3.)  Psychological disturbance (desire to correct a perceived anomaly).  These two antecedents will always be present in order to initiate the concept of surgery.  Cosmetic surgical procedures repair a psychological desire for improvement and though there may be no pathology or injury, these surgeries are valuable to patient’s psychological health (Perdue et al., 2018).

Though there is a need to perform surgery in sterile conditions they are not always required in emergent situations.  The surgeon need not be present for the performance of surgery as there are instances of robotic surgery where an individual at a distance can perform the surgery without ever touching the patient.  Though surgery is often a complex act that often requires a specialist to perform them, there are some surgical procedures that are routine and can be completed by an assistant, so a surgeon is not necessarily an antecedent for the performance of all surgery.

The optimal success of surgery often requires collaboration and assistance; however, it can be completed individually by a sole provider.  The presence of the surgical room and surgical table are ideal, but they are not required to initiate surgery.  Typically, surgery is performed with an anesthetic, but some patient conditions do not require anesthesia where the individual has loss of neural function or when they may use mental hypnotic techniques that would negate the use of traditional anesthetics for the performance of surgery.  The antecedents to surgery is the presence of surgical instruments and the existence of some form of tissue disturbance requiring surgery.

Model case

James is a 24-year-old man who married recently and worked in a construction company as a supervisor.  During his normal routine at work, equipment fell, and he was hit on the head, which resulted in the development of a subdural hematoma.  He was brought to the hospital by ambulance and his condition worsened causing him to lose consciousness.  His pupils were fixed and dilated, and he developed neural posturing and his hemodynamics were deteriorating rapidly.  A neurosurgeon suspecting herniation signed an emergency consent and rushed him to the operating room to perform a decompressive evacuation of the hematoma.  Upon evacuation of the hematoma and clipping of the bleeding vessel, James’s vital signs almost immediately stabilized.  He was taken in critical but stable condition to the neuro intensive care unit where he recovered and was discharged three days later without neurological deficit.

Borderline case

Caroline is a 21-year-old college student went to a party she was invited to from someone she had met online.  While at the party she drank too much and was given some unknown substance, which caused her to lose consciousness.  She woke up in the morning in a bath of ice and noticed a bloody bandage with an incision into left flank.  She had been kidnapped and her left kidney had been taken from her body without her consent and sold on the black market.

Related case

            Ken is a 21 year-old male client who works in a construction company.  While he was at work, he fell from the stairs and injured her hand.  He had mild pain and that evening while he was going back home, he decided to buy some painkillers and took them before he went to sleep.  When he woke up the following morning, he had severe pain with the hand inflamed and decided to visit a doctor.  He was assessed and an x-rays was ordered.  They x-rays results came and there was a small fracture which did not require surgical intervention according to the doctor.  He was informed and advised to avoid using the hand and also to continue with the pain relief.  He was advised to visit the facility after two weeks for checkup.  Two weeks later he came to the facility and there was a significant improvement.

Contrary case

  Jane is a 28-year-old single mom living in El Paso with her five-year-old son.  She has a history of a fracture in the scapula and has come to the health facility due to severe pain on the area where the scapula had fracture.  An x-ray was requested, and it showed a new fracture different from the one before.  The client reports that she was hit by the door but did not think that was the cause.  There was a need for surgery, but the client stated that she does not want to go for the surgery, and she wants only pain killers to help her control the pain.  She could not see the potential harm of the crack, advice from the health care workers was given, but the client responded negatively.  She was given pain relief and she reported she was better on a scheduled visit that was set for follow-up.

Invented case

             Evan is a 26-year-old male who woke up one morning with a severe headache.  He described the pain as the worst headache he had ever had.  He asked his house to call a health drone, which arrived within 3 minutes.  The health drone scanned his body and discovered a cerebral aneurysm.  The drone issued Evan a pill, which he consented to swallow.  The pill contained nano-surgical robots that were absorbed under his tongue into the vascular system.  The nano-robots traveled to the bleeding vessel built a stent with nano-particles which bypassed the rupture and directly repaired the tissue it in a matter of 7 minutes.  The drone ordered medications that would prevent seizures and infections to be added to all house food orders for Evan for the following two days.  Evan went to work the next day and has recovered fully.

Consequences

            Consequences are the incidences that come up due of the occurrence of the concept.  The consequence of surgery includes post-surgical pain and tissue loss.  When postoperative pain occurs, it is always a result of the surgery.  Although regional blocks and pain medications may alleviate the pain, they wear off or sometimes cannot control the pain due to the disruption of pain receptors and cause pain persistence depending on the severity of pain that the client is experiencing.

All surgical procedures result in loss of body tissue, and in many instances, it can result in loss of a whole organ or portion of it.  There is always a loss of surrounding tissues, fat or blood from the surgical site even if an implant is placed such as a pacemaker or a breast implant there is loss of blood or in the instance of dental caries, tooth loss is caused by the surgery.  Maybe the most dramatic example of loss would be in the situation of an amputation of a part of the body or a limb.  Removal of a leg will also result in emotional trauma at the loss of a body part and the psychology of loss regarding the functional impairment.

Many surgeries in addition to tissue loss cause loss of freedom as patients are frequently hospitalized.  There may be interference with the daily routines and habits of the person during recovery.  Loss of companionship separating the individual from their family or pets members which may create anxiety and fear.  Even veterinary surgery will cause damage of tissue and very often the loss of privilege as they are often confined or have protective devices placed on them that cause a loss of freedom of movement.

Empirical referents

            Empirical referents are the class or even categories of real phenomena in which their existence demonstrates the concept occurrence (Walker & Avant, 2011).  The critical attributes of the surgery are not abstract, the concept is more concrete and has a physical healing aspect.  The phrase “cold blue steel heals” is an empirical referent to the critical attributes of the invasive nature opening a tissue with consent to physically alter that tissue for the purpose of betterment of the organism.

Interrelationships

Though surgical tools and the presence of tissue disturbances must exist to proceed with surgical interventions, they tie in directly to the healing power of direct physical intervention.  The empirical referent of “cold blue steel heals” occurs only after the patient has been informed and consented in some form.  Where that consent cannot be obtained directly, it is assumed that the individual would have wanted to be repaired rather than allowed to die.  The consequences of surgery are pain and tissue loss regardless of the critical attribute being addressed.  No matter the etiology; injury, pathology or psychological disturbance, healing is the ultimate goal is to improve the lives of all surgical patients.

Relevance to Nursing

Nurses play a crucial role in the delivery of care to all the patients who undergo surgery, and it helps in better understanding and in promotion of ways that facilitate the provision of high-quality care to the clients.  Understanding the consent process will prevent wrong-site surgical procedures and will empower nurses to advocate for patients who are unable to provide consent.  An understanding of the concept of surgery helps nurses develop nursing interventions that assist their surgical clients and result in better outcomes (Hardin & Kaplow, 2019).  The development of surgical patient care plans focused on evidence-based practices that improve surgical outcomes promotes holistic nursing care.  Surgical patients who receive necessary care improve pain management aid self-care.

 

 

References

by Merriam-Webster, D. (2018). America's most-trusted online dictionary.(2017). Merriam-webster. com.

Castiglioni, A. (2018). A history of medicine (Vol. 2). Routledge.

 

Hardin, S. R., & Kaplow, R. (Eds.). (2019). Cardiac surgery essentials for critical care nursing. Jones & Bartlett Publishers.

Lawrence, C. (Ed.). (2018). Medical theory, surgical practice: studies in the history of surgery (Vol. 9). Routledge.

Perdue, T. O., Schreier, A., Neil, J., Carels, R., & Swanson, M. (2018). A Concept Analysis of Disturbed Body Image in Bariatric Surgery Patients. International journal of nursing knowledge.

Rothrock, J. C. (2018). Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences.

Walker, L. O. (81). Avant. KC (2011). Strategies for theory construction in nursing. New Jersey: Pearson/Prentice Hall.