Domain 11. Safety-protection
Class 2. Physical injury
Diagnostic Code: 00087
Nanda label: Risk for perioperative positioning injuryc
Diagnostic focus: Perioperative positioning injury
Nursing Diagnosis, a part of the nursing process, is defined by the NANDA-International (NANDA-I) as “A clinical judgement about individual, family, or community responses to actual and potential health problems/life processes”. It focuses on recognizing a client’s response to their current health status and includes classifying responses in terms of a risk for an actual or probable health problem. A Nursing Diagnosis often includes interventions and outcomes to be monitored, as well as ways to evaluate the success of its implementation. One such diagnosis is Risk for Perioperative Positioning Injury.
NANDA Nursing Diagnosis Definition
Risk for Perioperative Positioning Injury is defined as “the state in which an individual is at risk for injury or suffering trauma following positioning during a procedure or surgery”. This diagnosis highlights the potential for tissue damage and injuries caused by improper positioning of a patient during surgical or procedural operations.
Individuals with certain physical or mental conditions may be at a greater risk of experiencing perioperative positioning injuries. These can range from disease processes and conditions, to medication use and inadequate pre-operative education. Examples of risk factors include:
- Disease Processes and Conditions: Some medical conditions can contribute to a higher risk for perioperative positioning injury. This include diseases related to connective tissue, neurological damages or disorders, rheumatoid arthritis, and chronic joint pain.
- Medication Use: The use of certain analgesics or muscle relaxants can affect a patient’s ability to maintain proper positioning during surgery. This can lead to a higher risk of injury due to weakening of muscles and tissue.
- Inadequate Pre-Operative Education: Lack of understanding of proper post-operative positioning and activity can drastically increase the risk of an injury occurring.
At Risk Population
Patients in certain populations face an increased risk for developing perioperative positioning injury. These include elderly individuals, those with long-term conditions or weakened muscles, heavy individuals, and extremely tall patients. Examples of these at-risk individuals include:
- Elderly Patients: Due to physical limitations and weaker muscles associated with aging, elderly individuals are particularly at risk when it comes to positioning in an operating room.
- Long-Term Conditions/Weakened Muscles: Conditions such as joint pain, chronic muscular muscle strain, or damaged connective tissues all can adversely interfere with positioning in an operating room during a surgical procedure.
- Heavy Individuals: Patients who are particularly large can experience difficulty maneuvering their bodies into a desired position in the operating room, putting them at greater risk of suffering an injury.
- Extremely Tall Patients: Individuals that are taller than average might also have difficulty finding a suitable seated or lying position in the operating room. This can create situations in which the patient is more likely to experience discomfort or tissue damage.
There are many potential risks and direct consequences of perioperative positioning injury that clinicians and nurses need to be aware of. These can range from physical issues with tissue damage, to psychological issues such as feeling of shame or incompetence. Examples of these include:
- Tissue Damage: Tissue damage can occur in the form of compression and ulceration from being positioned in an uncomfortable or unnatural way during a procedure or surgery. This can manifest itself in many forms, such as pressure sores, nerve damage, or even in extreme cases, paralysis.
- Pain: Pain is one of the most common associated condition resulting from improper positioning in the operating room. This can range from mild discomfort to extreme mental anguish, depending on the severity of the injury.
- Embarassment: Many patients can feel ashamed of their condition or the possibility of it causing an injury. This can create feelings of embarrassment and worthlessness, leading to anxiety and depression.
Suggestions For Use
There are a number of safety measures and suggestions that nurses and healthcare providers can take to ensure that the potential for perioperative positioning injuries is minimized and managed effectively. These include:
- Provide thorough pre-operative educational materials on proper positioning techniques, both verbal and written.
- Schedule patients that are prone to needing special care, such as elderly individuals or those with weakened muscle tisssues, in the operating room before/after the busiest hours.
- Look for signs of iatrogenic causality, or any conditions that could potentially lead to an injury, and report them to a supervisor.
- Ensure that all necessary equipment and braces are on hand prior to positioning the patient.
- Communicate regularly with the patient to ensure that they are comfortable and able to move safely.
Suggested Alternative NANDA Nursing Diagnoses
There are also a number of other nursing diagnoses which can be considered if a health provider suspects that a patient is at risk of suffering a positioning injury in the OR. These other diagnoses include:
- Impaired Physical Mobility: A diagnosis involving movement difficulties, especially concerning bed positioning in a hospital setting.
- Activity Intolerance: A diagnosis involving fatigue or difficulty engaging in physical activities. This difficulty can contribute to an increase in risks for injury due to lack of activity.
- Injury Risk: A diagnosis focusing on the potential of a patient sustaining a physical injury due to causalities. Can be used in conjunction with other diagnoses to create a unique plan of care.
- Knowledge Deficit: A diagnosis focused on the lack of knowledge concerning perioperative positioning and its effects. This can make patients particularly vulnerable in an operating room setting.
When using the Risk for Perioperative Positioning Injury Nursing Diagnosis, it is important for healthcare professionals to ensure that the correct information and strategies are implemented in order to best serve the patient. To ensure proper usage, the following tips should be followed:
- Ensure that focus is placed on preemptive measures, such as patient education and comfort.
- Create a unique plan of care tailored to each individual patient.
- Maintain frequent communication with the patient to answer any questions or concerns.
- Be aware of any pre-existing conditions or disability that could lead to an increased chance of injury.
- Consult with a specialist if necessary.
The following NOC (Nursing Outcome Classification) Outcomes can be used to measure the success of preventive measures and interventions for preventing perioperative positioning injury:
- Mobility Level: This outcome assesses the patient’s ability to move around without any impediments. This scale ranges from 1-7 on a Likert Scale, with 7 representing complete control over one’s own mobility.
- Tissue Integrity: This outcome assesses any potential for damage or disruption of tissues in the body. The caregiver looks for various signs such as bruising, redness, swelling, or numbness.
- Self Care: This outcome assesses an individual’s ability to safely and independently perform activities of daily living, such as bathing, getting dressed, and eating. This scale can range from 1-7 on a Likert Scale, with 7 representing complete autonomy in daily activities.
- Skin Elasticity: This outcome assesses the presence of any permanent damage to skin due to extended physical contact with a surface, such as an operating table. The goal is to ensure that no lasting damage is done to the skin.
Evaluation Objectives and Criteria
Once a plan of care has been created and interventions have been implemented, it is important for healthcare professionals to evaluate the success of their efforts and ensure the wellbeing of the patient. In particular, clinicians should focus on the following objectives and criteria when assessing the patient’s condition:
- Assess the level of comfort the patient is experiencing during positioning in the operating room.
- Observe any physical changes that might signal tissue damage or injury.
- Monitor any changes in the patient’s self-care abilities.
- Check for any permanent changes to the skin elasticity of the patient.
NIC (Nursing Interventions Classification) interventions can be used to lessen the severity of risks posed by perioperative positioning injury. These involve various interventions and treatments aimed to prevent or alleviate any potential for injury. Examples of these interventions include:
- Education: Educating patients and family members on proper positioning techniques, as well as the potential consequences of positioning injuries, can go a long way in preventing accidents in operating rooms and elsewhere.
- Equipement Operation/Protocols: Ensuring that all necessary equipment is available beforehand, and that proper protocols are in place for operation and use, can be incredibly beneficial in making the OR safe for patients.
- Appropriate Exercise: Encouraging patients to engage in exercises that target the muscles needed for proper positioning can help to minimize the chances of injury.
- Mobilization: Through mobilization, nurses can help people overcome physical impairments and better manage their positioning. This can help to avoid potential injury from being positioned in a way not suited for the individual.
Nurses play a crucial role in recognizing, managing, and preventing patients from potentially suffering perioperative positioning injuries. This requires nurses to remain vigilant and take a number of key steps, including but not limited to:
- Identifying those at a higher risk for suffering a positioning injury in an OR setting.
- Provide pre-operative education and guidelines on proper positioning techniques.
- Be aware of any at-risk conditions or allergies, and alert the relevant personnel.
- Ensure that all necessary equipment is readily and properly available in the operating room.
- Encourage appropriate exercise for those at risk of tissue damage.
- Continuously monitor the patient during the procedure and provide support and comfort.
- Explain the potential consequences of positioning injuries and provide treatment and follow-up should any such injury occur.
Risk for Perioperative Positioning Injury is an increasingly prevalent nursing diagnosis that must be taken into consideration when dealing with patients undergoing procedures and surgeries in the OR. Nursing interventions, activities, assessments, and outcomes must all be taken into consideration in order to minimize the chance of a positioning injury occurring. The risk of injury increases significantly with certain populations and conditions, such as the elderly or heavy individuals. Thus, it is essential for nurses and healthcare professionals to remain ever-vigilant when dealing with such individuals and their positioning in the OR.
- Q: What is the Risk for Perioperative Positioning Injury Nursing Diagnosis?
A: Risk for Perioperative Positioning Injury is defined as “the state in which an individual is at risk for injury or suffering trauma following positioning during a procedure or surgery”. This diagnosis focused on highlighting the potential for tissue damage and injury caused by improper positioning of the patient during surgical or procedural operations.
- Q: Which populations are particularly at risk for this particular diagnosis?
A: Patients in specific populations are at an increased risk for developing perioperative positioning injury. These include patients that are elderly, heavy individuals, as well as those with long-term medical conditions or weakened muscles.
- Q: What interventions and assessments can be used to prevent positioning injuries in the OR?
A: Nurses and healthcare professionals can use a variety of interventions and assessments in order to reduce the severity of the risk of perioperative positioning injury. Interventions include providing pre-operative education and ensuring proper equipment is available in the OR. Assessments range from assessing mobility and skin elasticity, to monitoring changes in self-care ability.
- Q: Are there any NOC (Nursing Outcome Classification) Outcomes that can help measure the success of preventative measures and interventions?
A: Yes! There are a number of NOC Outcomes that can be used to measure the success of interventions focused on perioperative positioning injury. These include Mobility Level, Tissue Integrity, Self Care, and Skin Elasticity.
- Q: What roles do nurses play in preventing perioperative positioning injuries?
A: Nurses play a key role in recognizing, managing, and preventing patients from suffering perioperative positioning injuries. This involves identifying those who are at high risk and providing pre-operative education and guidelines on proper positioning techniques. Nurses should be aware of any at-risk conditions and ensure that all necessary equipment is readily and properly available in the operating room. Furthermore, nurses should continuously monitor the patient during the procedure and provide treatment and follow-up should any such injury occur.