Perspective
Nursing care and outcome in surgical patients –
They continuously work in very close contact with patients [1].
why do we have to care? In many situations, nurses are the first contact for patients
and face not only the illness-related complications that
https://doi.org/10.1515/iss-2019-0010 caused the hospitalization of the patient in the first place, but
Received May 15, 2019; accepted June 24, 2019; previously published also all other issues the patients experience during their
online July 25, 2019 hospital stay. This requires advanced professional nursing
qualification and expertise in the field.
Abstract: Nurses have an important role in patient care. They
continuously work in very close contact with
patients and foster the realization of activities of daily living as
well as ensure quality medical treatment. For both, a high Nursing in Germany
educational level is needed. A large proportion of patients
with complex health situations involving chronic illnesses and In Germany, nursing is an independent health profession [2].
multimorbidities are treated in hospitals with shortened The members of this profession carry out “their activities
hospital lengths of stay, changing the caring needs and the independently and under their own responsibility, in
demands on nursing. Nurses must handle complex nursing accordance to the level of knowledge” ([2], p. 378). Nursing is
tasks for which a higher educational level is indispensable, an integral part of health care and encompasses the
including the ability to implement evidence-based practice. In assessment, planning, execution, and evaluation of nursing
addition, studies show a correlation between the educational procedures [3].
level of nursing staff and the health outcomes of patients. If Thereby, nursing includes the protection of health, the
there are too few highly educated nurses, there is an increase prevention of illness, and the care of physically and mentally
in patient mortality as well as the risk of patient ill and disabled persons of all ages, in all healthcare and
complications, such as falls. Also, a low number of nursing community settings [4]. Nurses play a key role in the
staff and a high proportion of admissions decrease the quality successful delivery of health services.
of nursing and result in unfavorable patient outcomes. Both Nurses take care of the outcomes of diseases and
developments call for the necessity of a changing nursing suffering. They assist patients in the accomplishment of the
practice and the possibilities to transform interprofessional activities of daily living, which are normally limited or
work. impossible after surgery. Appropriate high-level nursing
competencies are necessary, because even simple tasks, such
Keywords: nursing competencies; nursing skill-mix; patient
as personal hygiene or mobility, cannot be performed by the
outcome; surgical patients.
patient alone due to limitations caused by the surgery. This
includes surgery-related limitations in mobility as well as in
combination with other existing restrictions. Furthermore,
Introduction medical treatments, such as wound care and drug therapy,
also require high competencies in nursing. Both the support in
Good patient outcome has become exceedingly important activities of daily living and the assumed tasks of medical
and the primary treatment goal of hospitals. To achieve this, treatment ask for high-level knowledge and skills as well as
a well-coordinated treatment process by all participating competencies to act adequately.
occupational groups is needed. In addition to surgeons and
Nurses contribute to and partake in medical diag-
other therapeutic professionals, nurses have a pivotal role.
7342 -0394
*Corresponding author: Asst. Prof. Dr. Nadja Nestler, Institute of nostics and therapy. Traditionally, these were delegated
Nursing Science and Practice, Paracelsus Medical University, tasks by physicians, including drug administration or wound
Strubergasse 21, 5020 Salzburg, Austria, care. However, these activities are increasingly being
E-mail: . https://orcid.org/0000-0002-
, allocated to the scope of nursing [5]. While drug stay, there are more patients with high-level and complex
administration, such as analgesic therapy, is carried out nursing care needs, resulting in the need to change nursing
140 Nestler: Nursing care and outcome in surgical competencies.
patients
within defined therapy schemes, wound care is often
Dependence of patient outcomes
carried out independently by nurses. In addition to this, on care
nurses have become specialists in the field of pain
management. For example, since the national Expert In surgery departments, nursing care frequently occurs
Standard for Pain Management in Nursing was independently and in coordination with the treating
published in 2005, 14,000 nurses have been trained in
pain management [6]. These are called pain nurses and
are pain specialists who address acute pain or are
responsible for the pain management at their ward [7].
They also develop concepts for pain therapy in physicians and the corresponding prescription. Usually, nurses
collaboration with physicians and evaluate its are the primary contact for patients. They have to assess the
realization as well as effectiveness. Nursing specialists, competencies in the activities of daily living as well as after
like pain or wound care nurses, secure the nursing surgery and evaluate further need for assistance, and are the
routine by directly caring for patients with complex care first ones who communicate with the physician and other
needs and act as consultants for colleagues and patients occupational groups for planning the treatment process.
due to their special knowledge and skills. They support patients during all recovery phases. During
However, especially against the backdrop of a the different stages of surgery (preoperative, intraoperative,
changing society and the associated changing demands and postoperative phases of surgery), diverse roles of nurses
on the occupational field of nursing, the spectrum of and care competencies are needed [12]. In every phase, nurses
tasks and the field of action in nursing are changing [5]. must know the entire perioperative process to adequately plan
In Germany, the population is aging, bringing about an the complete treatment right from the beginning. While in the
increase of chronic and age-associated diseases preoperative phase, nurses should prepare patients by
resulting in consistently higher and complex needs with anticipating possible fears and support the patient in preparing
increasing population numbers [8]. him or her for the surgery. In the postoperative phase, it is the
aim to minimize potential complications, promote
Chronically ill and predominantly older people tend
independence, and educate patients for a faster and safe
to increasingly stay in hospitals, changing the demands
recovery [13]. Prior to the surgery, nurses are expected to
on the culture of nursing [9]. In addition to treating the
prepare the patients to be in the best condition for surgery [14].
main acute problem, these chronically ill patients
Because of this, their teaching and information role becomes
present with a number of pre-existing medical
more important. As the patient’s length of stay is often rather
conditions that not only make them experts in their own
short, structured pathways become more significant.
illness in their specific life situation [10] but also make
them want to participate in the treatment process, each Due to these conditions, there is a need for evidencebased
according to their own competencies. This complicates nursing as well as individual support for the treated patient.
the care process in the hospital. The restrictions Otherwise, there is the danger of mechanical nursing, only
associated with pre-existing diseases also affect the orienting itself on a medical protocol [14] but without
recovery process of the acute disease and can have a recognizing the individual needs of the patient. Nurses must
direct influence on nursing [9]. know the procedures during the entire perioperative process,
but they should also notice and look after the individual health
Further, there is a reduction in hospital length of
situation of the patient and his or her individual needs. Patients
stay. Since 2000, the hospital length of stay has
do have a gamut of physiological, psychological, and emotional
decreased from 9.2 to 7.3 days [11], meaning that
responses to surgery (Figure 1).
hospitalized patients are discharged earlier to return
home or be transferred to institutions providing further Nurses must recognize this and appropriately consider the
care. Because of this shortening of hospital length of nursing process. While there is a nursing
Nursing care and outcome in surgical patients –
They continuously work in very close contact with patients [1].
why do we have to care? In many situations, nurses are the first contact for patients
and face not only the illness-related complications that
https://doi.org/10.1515/iss-2019-0010 caused the hospitalization of the patient in the first place, but
Received May 15, 2019; accepted June 24, 2019; previously published also all other issues the patients experience during their
online July 25, 2019 hospital stay. This requires advanced professional nursing
qualification and expertise in the field.
Abstract: Nurses have an important role in patient care. They
continuously work in very close contact with
patients and foster the realization of activities of daily living as
well as ensure quality medical treatment. For both, a high Nursing in Germany
educational level is needed. A large proportion of patients
with complex health situations involving chronic illnesses and In Germany, nursing is an independent health profession [2].
multimorbidities are treated in hospitals with shortened The members of this profession carry out “their activities
hospital lengths of stay, changing the caring needs and the independently and under their own responsibility, in
demands on nursing. Nurses must handle complex nursing accordance to the level of knowledge” ([2], p. 378). Nursing is
tasks for which a higher educational level is indispensable, an integral part of health care and encompasses the
including the ability to implement evidence-based practice. In assessment, planning, execution, and evaluation of nursing
addition, studies show a correlation between the educational procedures [3].
level of nursing staff and the health outcomes of patients. If Thereby, nursing includes the protection of health, the
there are too few highly educated nurses, there is an increase prevention of illness, and the care of physically and mentally
in patient mortality as well as the risk of patient ill and disabled persons of all ages, in all healthcare and
complications, such as falls. Also, a low number of nursing community settings [4]. Nurses play a key role in the
staff and a high proportion of admissions decrease the quality successful delivery of health services.
of nursing and result in unfavorable patient outcomes. Both Nurses take care of the outcomes of diseases and
developments call for the necessity of a changing nursing suffering. They assist patients in the accomplishment of the
practice and the possibilities to transform interprofessional activities of daily living, which are normally limited or
work. impossible after surgery. Appropriate high-level nursing
competencies are necessary, because even simple tasks, such
Keywords: nursing competencies; nursing skill-mix; patient
as personal hygiene or mobility, cannot be performed by the
outcome; surgical patients.
patient alone due to limitations caused by the surgery. This
includes surgery-related limitations in mobility as well as in
combination with other existing restrictions. Furthermore,
Introduction medical treatments, such as wound care and drug therapy,
also require high competencies in nursing. Both the support in
Good patient outcome has become exceedingly important activities of daily living and the assumed tasks of medical
and the primary treatment goal of hospitals. To achieve this, treatment ask for high-level knowledge and skills as well as
a well-coordinated treatment process by all participating competencies to act adequately.
occupational groups is needed. In addition to surgeons and
Nurses contribute to and partake in medical diag-
other therapeutic professionals, nurses have a pivotal role.
7342 -0394
*Corresponding author: Asst. Prof. Dr. Nadja Nestler, Institute of nostics and therapy. Traditionally, these were delegated
Nursing Science and Practice, Paracelsus Medical University, tasks by physicians, including drug administration or wound
Strubergasse 21, 5020 Salzburg, Austria, care. However, these activities are increasingly being
E-mail: . https://orcid.org/0000-0002-
, allocated to the scope of nursing [5]. While drug stay, there are more patients with high-level and complex
administration, such as analgesic therapy, is carried out nursing care needs, resulting in the need to change nursing
140 Nestler: Nursing care and outcome in surgical competencies.
patients
within defined therapy schemes, wound care is often
Dependence of patient outcomes
carried out independently by nurses. In addition to this, on care
nurses have become specialists in the field of pain
management. For example, since the national Expert In surgery departments, nursing care frequently occurs
Standard for Pain Management in Nursing was independently and in coordination with the treating
published in 2005, 14,000 nurses have been trained in
pain management [6]. These are called pain nurses and
are pain specialists who address acute pain or are
responsible for the pain management at their ward [7].
They also develop concepts for pain therapy in physicians and the corresponding prescription. Usually, nurses
collaboration with physicians and evaluate its are the primary contact for patients. They have to assess the
realization as well as effectiveness. Nursing specialists, competencies in the activities of daily living as well as after
like pain or wound care nurses, secure the nursing surgery and evaluate further need for assistance, and are the
routine by directly caring for patients with complex care first ones who communicate with the physician and other
needs and act as consultants for colleagues and patients occupational groups for planning the treatment process.
due to their special knowledge and skills. They support patients during all recovery phases. During
However, especially against the backdrop of a the different stages of surgery (preoperative, intraoperative,
changing society and the associated changing demands and postoperative phases of surgery), diverse roles of nurses
on the occupational field of nursing, the spectrum of and care competencies are needed [12]. In every phase, nurses
tasks and the field of action in nursing are changing [5]. must know the entire perioperative process to adequately plan
In Germany, the population is aging, bringing about an the complete treatment right from the beginning. While in the
increase of chronic and age-associated diseases preoperative phase, nurses should prepare patients by
resulting in consistently higher and complex needs with anticipating possible fears and support the patient in preparing
increasing population numbers [8]. him or her for the surgery. In the postoperative phase, it is the
aim to minimize potential complications, promote
Chronically ill and predominantly older people tend
independence, and educate patients for a faster and safe
to increasingly stay in hospitals, changing the demands
recovery [13]. Prior to the surgery, nurses are expected to
on the culture of nursing [9]. In addition to treating the
prepare the patients to be in the best condition for surgery [14].
main acute problem, these chronically ill patients
Because of this, their teaching and information role becomes
present with a number of pre-existing medical
more important. As the patient’s length of stay is often rather
conditions that not only make them experts in their own
short, structured pathways become more significant.
illness in their specific life situation [10] but also make
them want to participate in the treatment process, each Due to these conditions, there is a need for evidencebased
according to their own competencies. This complicates nursing as well as individual support for the treated patient.
the care process in the hospital. The restrictions Otherwise, there is the danger of mechanical nursing, only
associated with pre-existing diseases also affect the orienting itself on a medical protocol [14] but without
recovery process of the acute disease and can have a recognizing the individual needs of the patient. Nurses must
direct influence on nursing [9]. know the procedures during the entire perioperative process,
but they should also notice and look after the individual health
Further, there is a reduction in hospital length of
situation of the patient and his or her individual needs. Patients
stay. Since 2000, the hospital length of stay has
do have a gamut of physiological, psychological, and emotional
decreased from 9.2 to 7.3 days [11], meaning that
responses to surgery (Figure 1).
hospitalized patients are discharged earlier to return
home or be transferred to institutions providing further Nurses must recognize this and appropriately consider the
care. Because of this shortening of hospital length of nursing process. While there is a nursing
