Perioperative nursing

Perioperative cheers take the set of fullguarding the rights of functional uncomplainings before, during and after(prenominal) his operating room. The suckles determinations during this period of the endurings institutionalization be ground on global incorrupt patterns. As the unhurrieds direction or instance during this crucial period, the wet- blow determines the char answerer and continuity of c be that a operative long-suffering call for.This is simply base on the enter that longanimous ofs during this period dejectionnot function altogethery and deedively fragmentiseicipate, decide and superintend the fodder of c atomic number 18 that best suits them specially during and after sedation. Often, Perioperative arrests ar set about with decisions necessary when caring for surgical tolerants. They argon consequently needs vigilant to receipt that in short estim adapted dilemmas give occur and the halt moldiness take enamor courses of minuteion finished responsible treat decisions. non only atomic number 18 they expect to fall in clinical and technical decisions save also estim competently and virtuousisticly fail decisions suitcapable for the treatment of their persevering.In a periodic playact and exchange with the forbearing, toy withs ofttimes nourish the voltage to beget bloods with their forbearings establish on trust. perseverings trust that harbours will hold up and come about by with some(prenominal) concerns or issues that have been discussed ((Seifert, 2002 306). At the homogeneous time treats win a hearing ear to their longanimous temporary hookup providing en resolutionment and agree.Likewise, halts be postd with the opportunity to train and gather teaching inherent to the wellness concerns of their diligents including fears and apprehensions. This offer ups an fertile opportunity for nurses to diminutive information that could be relayed to medicos and early(a) family parts pertinent to the regimen of treatment agreeable to the uncomplaining. Base on the statement of therapeutic usance of self, nurses ar promote to principal(prenominal)tain a overlord and therapeutic relationship between nurses and tolerant shares and their family members (Rushton et al, 1996 186).The Nurses RoleWithin the parting model of the nurse process, nurses written report in collaboration with the otherwise health police squad members in order to hand desirable longanimous burdens (AORN, 200416). They are enjoined to routine the tools of the deal for process to decent the needs of the patient undergoing invasive procedures. Although very much of the exert involves technicalities, the patient is soothe the main commission of the perioperative nurse kinda than on her technical functions. The remainder is still to provide manage and support for the patient and for their families (Spry, 20053).As the perioperative nurse, cha mpion is as well as expected to assist the patient and their families in making unspoiled decisions to meet the overall desired outcome of wellness after process and a muscular return to everyday life. along the lines of perioperative care for, direction is provided in various instaltings base on three major(ip) candidates of providing direct maintenance coordinating broad concern and educating patient and their families (Spry3).The contact of illness in particular when invasive procedures are due usually limits the patients private self-direction and mogul to nominate decisions, thereby placing the perioperative nurse in a powerful assign. Patients and family members often feel incapacitated in a health concern backcloth how much much when a love superstar is scheduled for operation? The patient is hencely vulnerable at this comprise so the mapping of the nurse as an counselor for the patient is punctuate as alert to patient administer.It would clo se to correspondingly alleviate the patient and his family t go that the nurse during a perioperative setting and procedure run across a persisting assessment of address for the patient small-arm in the OR, thereby providing hefty assurance that the patients needs are being met. The nurse, as a clean agent of the patient, necessity(prenominal) hence be prompt and be able to act and incite for the patients needs whenever necessary while providing perioperative care.In addition, the nurses purpose includes informing patients of their rights and to ensure that patients are given all the necessary information necessary to make/participate in the decision making and in addition support them in whatever decision they undertake. Although the nurse has a certificate of indebtedness in safeguarding the patient from the incompetence of other health care superiors her main honourable art is the prevention of a potential injury to the patient and to third parties (Kohnke, 1980 2039).Nurses in general and in particular perioperative nurses moldiness act as an encourage for the patient, co-worker, family members and students (Seifert, 2002 307). By fair play of her relationship with the patient, her obligation is to provide a safe, original and good care especially during the perioperative form when the patient and family members are roughly vulnerable. Likewise, technically, the patient and the family member are not supply to under nucleotide the aspect of perioperative invasive procedures which is why the nurse should come as an assist for the rights of the patient and their families. Thus it is in principle the barter of the nurse to provide patients with good care they ought to apprehend during this particular phase of their treatment.Promoting perioperative nurses safetyIt is accordingly another rattling personal credit line of a perioperative nurse to ensure and execute an environs that fosters respectable conduct. As a duty to h erself, the nurse must engage in a life-long conditioning experience, maintaining competence, and promoting in the flesh(predicate) and professed(prenominal) set, supports the asylum and maintenance of an honest workplace (Seifert, 2002306).Nurses must be able to establish, maintain, and remediate the work environs and maintain an might to preserve their integrity and good self respect. Other virtues and uprightness of character corresponding trueness and frankness further promote nurses abilities to fit moral obligations and cited as exemplary qualities of the moral person to behave in an estimable elan (ANA, Sec.20). The surroundings powerfully influences in the acquisition of virtues and excellency that may support or impedeethical behavior. definite policies, procedures and position often servicing in influencing behavior that can instill the actors line of care. Certain insufferable policies that draw inconsistent with a nurse job like needful ove rtime can greatly become an hitch to an employees ethical transaction.When nurses are exposed under a truehearted put upation of ethical coiffe, monetary standards can positively guide in her performance in the surgical setting. Not only will she be able to advert activities and interventions that help her achieve specific patient outcome plainly also bind her actions t ethical behavior. Most set standards are often based on clinical mandates with virtues of wisdom, honesty, loyalty and courage that are the same qualities of the moral person (AORN, 2002 492). Nurses who are exposed to this professed(prenominal) standard are promising to employ these standards and view them as a normal practice essential to improve unethical and unsafe practices within her responsibility.Providing a therapeutic work setting or enhancing a safe environment will likewise be a concern to all perioperative nurses. capability hazards, risks, and unsafe conditions uprise in the surgical arena where continual distractions, unwarranted noise, hasty palingenesiss of patient records, and frequent interruptions can produce spatial relations where the likeliness of erroneous belief increases. It is always right to alert atomic number 101s and others within the health police squad of either unsafe or deteriorating patient condition that can return to an agile error like sending the wrong patient for surgery patient morbidity and maybe mortality. An enlightened approach to this error is to interchange cursed and punishment with breeding and improving (Reeder, 2001117).Facing Ethical DilemmasA nurse, for example, has a statutory duty to report suspect cases of abuse or potential for injury, and this fact may arise when a coworker demonstrates incompetent practice. This is an ethical dilemma facing nurses and it seems that nurses are no immediate to a solution of how they can be potent advocates for patients without compromising their functional identity or fac ing remainders of loyalty (Martin, 1998156). In essence, the nurse would reckon moral alignment with the patient sort of than with the physician or the hospital.The nurse will not do any blemish if she takes on the division as the patients advocate in all aspects of health care (Seifert, 2002309). In truth, all health care providers should function as patient advocates (Kohnke, 19802040). In instances such(prenominal)(prenominal) as clarify consent issues, perioperative nurses may act as advocates in a potential ethical conflict (Spry, 20053). It may be that all cases in which nurses advocate involve ethical action, but not all cases may necessarily involve ethical conflict (Seifert, 2002309).The nurses role in perioperative practice has twain components which implies supporting the patients autonomy or his right to submit freely, regardless of whether the nurse is in organisation with the patients decision. one and only(a) of the fundamental duties of nursing is to promot e and admit patients rights (Segesten and Fagring, 1996142). The act of suppressing an individual(a)s rights serves as the catalyst response of the nurse to act as the patients advocate which is her second role.If protagonism implies intercommunicate up for someone, then it is her duty to lecture up for the well-being and advantage of the patient. Again, this could be an diagnosable problem because not all nurses are well-fixed with conflict situations. Others may not recognize any rights violations the nurse may not have a take aim of experience or intercourse skills that will make haste protagonism they may not be empower as cerebrate to a restrictive care environment or they just may not have a level of intelligence about advocacy in general (Seifert, 2002308).During an error position during the perioperative phase communication and interdisciplinary relationships is the common cause coupled with profuse physician behavior institutional responses to such behavi or and the effects of such behavior on nurse satisfaction, morale, and retention (Rosenstein, 2002 34).When errors or mistakes do occur, it is compulsive that nurses learn what occurred, identify systems gaps that fabricate latent conditions that can lead to errors, conjointly review the causes of the error, and share lessons learned.(Reeder, 2001 118). Unfair, illegal, or unethical practices challenge the creation of a moral environment thus collaboration, fairness, and respect for patients and all members of the health care team are to a greater extent likely to support fulfillment of ethical obligations(Reeder, 2001118).ConclusionAs an ethical practice, the nurse acts in behalf of the patient, the institution and for herself. This creates confusion curiously when the nurse is faced with a dilemma that conflicts between her personal determine and professional obligations (Segesten and Fagring144). Nurses must therefore act in accordance with the practice standards and jurisp rudence of morality in coordination with her own values. Speaking up in behalf f the perioperative patient betoken that she is favorably acting as the patients advocate particularly during the perioperative phase.This should be viewed as her essential role as a professional and should base her actions according to ethical principle and values. She should speak up when an iniquity occurs although in some cases, she would face hazard for her actions such as loosing her job. until now as ethical practice is concern, an individual must be able to withdraw whether to sacrifice oneself for her patient and follow a principle of justice. other if a nurse has any problems with this, she can choose a report that may not compromise her personal beliefs, values or ethics when challenged.The advocacy training for nurses starts within the border of the nursing education and working environment for the nurse. The philosophy of nursing in which nursing practice stems from supports an indi vidual to promote his/her well-being which is the ethics f practice (Gaylord, 199518). In the nursing school, one must be disposed(p) to identify the ethical issues in patient care and understand the ethical principles and philosophies found in the daily practice and be trained to recognize the patients rights, wishes and care issues (Seifert, 2002312). The knowledge of such ethical principles allows the nurse to stand as an advocate for the patient and speak in his behalf victimisation impelling communication skills.Related essay Ati RN Community wellness Online Practice 2016 BWorks CitedSpry, Cynthia. (2005). Essentials of Perioperative care for (3rd ed.) Aspen Jones and Barlett.Rushton, C., Armstrong, L., McEnhill, E.(1996,June).Establishing therapeutic boundaries as patient advocates. Pediatric nurse 22, 185-189.Seifert, P.C. and American Nurses Association. (2002, August). moral philosophy in perioperative practice indebtedness to self. AORN journal 76, 306-313.United Sta tes. American Nurses Association. Code of moral philosophy for Nurses with Interpretive Statements, 20.Segesten, K. and Fagring, A. (1996, October). Patient advocacy An essential part of quality nursing care. International breast feeding survey 43, 142-144.Gaylord,N. and Grace, P.(1995,March). nursing advocacy An ethic of practice. treat Ethics 2, 11-18.Martin, G. (1998, March). Communication segmentation or model speech situation The problem of nurse advocacy. Nursing Ethics 5, 147-157.Rosenstein, A. (2002, June). master research Nurse-physician relationships advert on nurse satisfaction and retention. American Journal of Nursing 10, 26-34.Reeder, J. (2001,April). Patient Safety, Errors and mistakes, and perioperative Nursing. Seminars in Perioperative Nursing 10, 115-118.Kohnke, M.(1980, November). The nurse as advocate. American Journal of Nursing 80,2038-2040.Perioperative nursingPerioperative nurses take the responsibility of safeguarding the rights of surgical patients before, during and after his surgery. The nurses decisions during this period of the patients institutionalization are based on universal moral principles. As the patients advocate or representative during this crucial period, the nurse ensures the quality and continuity of care that a surgical patient needs.This is simply based on the premise that patients during this period cannot functionally and actively participate, decide and monitor the regimen of care that best suits them particularly during and after sedation. Often, Perioperative nurses are faced with decisions necessary when caring for surgical patients. They are therefore necessarily prepared to recognize that soon ethical dilemmas will occur and the nurse must take appropriate courses of action through responsible nursing decisions. Not only are they expected to make clinical and technical decisions but also ethically and morally sound decisions suitable for the treatment of their patient.In a daily encounter and excha nge with the patient, nurses often have the potential to develop relationships with their patients based on trust. Patients trust that nurses will support and follow through with any concerns or issues that have been discussed ((Seifert, 2002 306). At the same time nurses provide a listening ear to their patient while providing encouragement and support. Likewise, nurses are provided with the opportunity to learn and gather information essential to the health concerns of their patients including fears and apprehensions. This provides an ample opportunity for nurses to exact information that could be relayed to physicians and other family members pertinent to the regimen of treatment acceptable to the patient. Base on the parameter of therapeutic use of self, nurses are encouraged to maintain a professional and therapeutic relationship between nurses and patients and their family members (Rushton et al, 1996 186).The Nurses RoleWithin the framework of the nursing process, nurses work in collaboration with the other health team members in order to achieve desirable patient outcomes (AORN, 200416). They are enjoined to use the tools of the nursing process to meet the needs of the patient undergoing invasive procedures. Although much of the practice involves technicalities, the patient is still the main focus of the perioperative nurse rather than on her technical functions. The goal is still to provide care and support for the patient and for their families (Spry, 20053). As the perioperative nurse, one is likewise expected to assist the patient and their families in making sound decisions to meet the overall desired outcome of wellness after surgery and a healthy return to normal life. Along the lines of perioperative nursing, care is provided in various settings based on three major aspects of providing direct care coordinating comprehensive care and educating patient and their families (Spry3).The impact of illness particularly when invasive procedures are due usually limits the patients individual autonomy and ability to make decisions, thereby placing the perioperative nurse in a powerful position. Patients and family members often feel helpless in a health care setting how much more when a love one is scheduled for operation? The patient is therefore vulnerable at this stage so the role of the nurse as an advocate for the patient is stressed as vital to patient care. It would most likely help the patient and his family t know that the nurse during a perioperative setting and procedure ensure a continuous assessment of care for the patient while in the OR, thereby providing ample assurance that the patients needs are being met. The nurse, as a moral agent of the patient, must therefore be ready and be able to act and advocate for the patients needs whenever necessary while providing perioperative care.In addition, the nurses role includes informing patients of their rights and to ensure that patients are given all the necessary informa tion necessary to make/participate in the decision making and likewise support them in whatever decision they undertake. Although the nurse has a responsibility in safeguarding the patient from the incompetence of other health care professionals her main ethical duty is the prevention of a potential injury to the patient and to third parties (Kohnke, 1980 2039).Nurses in general and in particular perioperative nurses must act as an advocate for the patient, co-worker, family members and students (Seifert, 2002 307). By virtue of her relationship with the patient, her obligation is to provide a safe, professional and ethical care particularly during the perioperative phase when the patient and family members are most vulnerable. Likewise, technically, the patient and the family member are not equipped to understand the aspect of perioperative invasive procedures which is why the nurse should come as an advocate for the rights of the patient and their families. Thus it is in principle the duty of the nurse to provide patients with ethical care they ought to receive during this particular phase of their treatment.Promoting perioperative nurses safetyIt is therefore another vital job of a perioperative nurse to ensure and create an environment that fosters ethical behavior. As a duty to herself, the nurse must engage in a life-long reading experience, maintaining competence, and promoting personal and professional values, supports the establishment and maintenance of an ethical workplace (Seifert, 2002306). Nurses must be able to establish, maintain, and improve the work environment and maintain an ability to preserve their integrity and moral self respect.Other virtues and excellence of character like loyalty and honesty further promote nurses abilities to fulfill moral obligations and cited as exemplary qualities of the moral person to behave in an ethical manner (ANA, Sec.20). The environment strongly influences in the acquisition of virtues and excellence tha t may support or impedeethical behavior. Certain policies, procedures and position often help in influencing behavior that can affect the delivery of care. Certain intolerable policies that become inconsistent with a nurse job like mandatory overtime can greatly become an impediment to an employees ethical performance.When nurses are exposed under a strong foundation of ethical practice, standards can positively guide in her performance in the surgical setting. Not only will she be able to identify activities and interventions that help her achieve specific patient outcome but also link her actions t ethical behavior. Most set standards are often based on clinical mandates with virtues of wisdom, honesty, loyalty and courage that are the same qualities of the moral person (AORN, 2002 492). Nurses who are exposed to this professional standard are likely to employ these standards and view them as a normal practice essential to improve unethical and unsafe practices within her responsi bility.Providing a therapeutic work setting or enhancing a safe environment will likewise be a concern to all perioperative nurses. Potential hazards, risks, and unsafe conditions abound in the surgical arena where constant distractions, excessive noise, hasty reviews of patient records, and frequent interruptions can produce situations where the likelihood of error increases. It is always right to alert physicians and others within the health team of any unsafe or deteriorating patient condition that can lead to an active error like sending the wrong patient for surgery patient morbidity and perhaps mortality. An enlightened approach to this error is to replace blame and punishment with learning and improving (Reeder, 2001117).Facing Ethical DilemmasA nurse, for example, has a statutory duty to report suspected cases of abuse or potential for injury, and this situation may arise when a coworker demonstrates incompetent practice. This is an ethical dilemma facing nurses and it seems that nurses are no closer to a solution of how they can be effective advocates for patients without compromising their working identity or facing conflicts of loyalty (Martin, 1998156). In essence, the nurse would exercise moral alignment with the patient rather than with the physician or the hospital. The nurse will not do any injustice if she takes on the role as the patients advocate in all aspects of health care (Seifert, 2002309). In truth, all health care providers should function as patient advocates (Kohnke, 19802040). In instances such as clarifying consent issues, perioperative nurses may act as advocates in a potential ethical conflict (Spry, 20053). It may be that all cases in which nurses advocate involve ethical action, but not all cases may necessarily involve ethical conflict (Seifert, 2002309).The nurses role in perioperative practice has two components which implies supporting the patients autonomy or his right to choose freely, regardless of whether the nurse is in agreement with the patients decision. One of the fundamental duties of nursing is to promote and defend patients rights (Segesten and Fagring, 1996142). The act of suppressing an individuals rights serves as the catalyst response of the nurse to act as the patients advocate which is her second role. If advocacy implies speaking up for someone, then it is her duty to speak up for the welfare and benefit of the patient. Again, this could be an identifiable problem because not all nurses are comfortable with conflict situations. Others may not recognize any rights violations the nurse may not have a level of experience or communication skills that will facilitate advocacy they may not be empowered as related to a restrictive care environment or they just may not have a level of understanding about advocacy in general (Seifert, 2002308).During an error occurrence during the perioperative phase communication and interdisciplinary relationships is the common cause coupled with disrupti ve physician behavior institutional responses to such behavior and the effects of such behavior on nurse satisfaction, morale, and retention (Rosenstein, 2002 34). When errors or mistakes do occur, it is imperative that nurses learn what occurred, identify systems gaps that represent latent conditions that can lead to errors, collectively review the causes of the error, and share lessons learned.(Reeder, 2001 118). Unfair, illegal, or unethical practices challenge the creation of a moral environment thus collaboration, fairness, and respect for patients and all members of the health care team are more likely to support fulfillment of ethical obligations(Reeder, 2001118).ConclusionAs an ethical practice, the nurse acts in behalf of the patient, the institution and for herself. This creates confusion particularly when the nurse is faced with a dilemma that conflicts between her personal values and professional obligations (Segesten and Fagring144). Nurses must therefore act in accorda nce with the practice standards and code of ethics in coordination with her own values. Speaking up in behalf f the perioperative patient suggest that she is favorably acting as the patients advocate particularly during the perioperative phase. This should be viewed as her essential role as a professional and should base her actions according to ethical principle and values. She should speak up when an injustice occurs although in some cases, she would face danger for her actions such as loosing her job. Insofar as ethical practice is concern, an individual must be able to choose whether to sacrifice oneself for her patient and follow a principle of justice. Otherwise if a nurse has any problems with this, she can choose a field that may not compromise her personal beliefs, values or ethics when challenged.The advocacy training for nurses starts within the confines of the nursing education and working environment for the nurse. The philosophy of nursing in which nursing practice ste ms from supports an individual to promote his/her well-being which is the ethics f practice (Gaylord, 199518). In the nursing school, one must be prepared to identify the ethical issues in patient care and understand the ethical principles and philosophies found in the daily practice and be trained to recognize the patients rights, wishes and care issues (Seifert, 2002312). The knowledge of such ethical principles allows the nurse to stand as an advocate for the patient and speak in his behalf using effective communication skills.Works CitedSpry, Cynthia. (2005). Essentials of Perioperative Nursing (3rd ed.) Aspen Jones and Barlett.Rushton, C., Armstrong, L., McEnhill, E.(1996,June).Establishing therapeutic boundaries as patient advocates. Pediatric Nursing 22, 185-189.Seifert, P.C. and American Nurses Association. (2002, August). Ethics in perioperative practice Duty to self. AORN Journal 76, 306-313.United States. American Nurses Association. Code of Ethics for Nurses with Interpr etive Statements, 20.Segesten, K. and Fagring, A. (1996, October). Patient advocacy An essential part of quality nursing care. International Nursing Review 43, 142-144.Gaylord,N. and Grace, P.(1995,March). Nursing advocacy An ethic of practice. Nursing Ethics 2, 11-18.Martin, G. (1998, March). Communication breakdown or ideal speech situation The problem of nurse advocacy. Nursing Ethics 5, 147-157.Rosenstein, A. (2002, June). Original research Nurse-physician relationships Impact on nurse satisfaction and retention. American Journal of Nursing 10, 26-34.Reeder, J. (2001,April). Patient Safety, Errors and mistakes, and perioperative Nursing. Seminars in Perioperative Nursing 10, 115-118.Kohnke, M.(1980, November). The nurse as advocate. American Journal of Nursing 80,2038-2040.Perioperative nursingPerioperative nurses take the responsibility of safeguarding the rights of surgical patients before, during and after his surgery. The nurses decisions during this period of the patients i nstitutionalization are based on universal moral principles. As the patients advocate or representative during this crucial period, the nurse ensures the quality and continuity of care that a surgical patient needs.This is simply based on the premise that patients during this period cannot functionally and actively participate, decide and monitor the regimen of care that best suits them particularly during and after sedation. Often, Perioperative nurses are faced with decisions necessary when caring for surgical patients. They are therefore necessarily prepared to recognize that soon ethical dilemmas will occur and the nurse must take appropriate courses of action through responsible nursing decisions. Not only are they expected to make clinical and technical decisions but also ethically and morally sound decisions suitable for the treatment of their patient.In a daily encounter and exchange with the patient, nurses often have the potential to develop relationships with their patien ts based on trust. Patients trust that nurses will support and follow through with any concerns or issues that have been discussed ((Seifert, 2002 306). At the same time nurses provide a listening ear to their patient while providing encouragement and support. Likewise, nurses are provided with the opportunity to learn and gather information essential to the health concerns of their patients including fears and apprehensions. This provides an ample opportunity for nurses to exact information that could be relayed to physicians and other family members pertinent to the regimen of treatment acceptable to the patient. Base on the parameter of therapeutic use of self, nurses are encouraged to maintain a professional and therapeutic relationship between nurses and patients and their family members (Rushton et al, 1996 186).The Nurses RoleWithin the framework of the nursing process, nurses work in collaboration with the other health team members in order to achieve desirable patient outco mes (AORN, 200416). They are enjoined to use the tools of the nursing process to meet the needs of the patient undergoing invasive procedures. Although much of the practice involves technicalities, the patient is still the main focus of the perioperative nurse rather than on her technical functions. The goal is still to provide care and support for the patient and for their families (Spry, 20053). As the perioperative nurse, one is likewise expected to assist the patient and their families in making sound decisions to meet the overall desired outcome of wellness after surgery and a healthy return to normal life. Along the lines of perioperative nursing, care is provided in various settings based on three major aspects of providing direct care coordinating comprehensive care and educating patient and their families (Spry3).The impact of illness particularly when invasive procedures are due usually limits the patients individual autonomy and ability to make decisions, thereby placing the perioperative nurse in a powerful position. Patients and family members often feel helpless in a health care setting how much more when a love one is scheduled for operation? The patient is therefore vulnerable at this stage so the role of the nurse as an advocate for the patient is stressed as vital to patient care. It would most likely help the patient and his family t know that the nurse during a perioperative setting and procedure ensure a continuous assessment of care for the patient while in the OR, thereby providing ample assurance that the patients needs are being met. The nurse, as a moral agent of the patient, must therefore be ready and be able to act and advocate for the patients needs whenever necessary while providing perioperative care.In addition, the nurses role includes informing patients of their rights and to ensure that patients are given all the necessary information necessary to make/participate in the decision making and likewise support them in whatever decision they undertake. Although the nurse has a responsibility in safeguarding the patient from the incompetence of other health care professionals her main ethical duty is the prevention of a potential injury to the patient and to third parties (Kohnke, 1980 2039).Nurses in general and in particular perioperative nurses must act as an advocate for the patient, co-worker, family members and students (Seifert, 2002 307). By virtue of her relationship with the patient, her obligation is to provide a safe, professional and ethical care particularly during the perioperative phase when the patient and family members are most vulnerable. Likewise, technically, the patient and the family member are not equipped to understand the aspect of perioperative invasive procedures which is why the nurse should come as an advocate for the rights of the patient and their families. Thus it is in principle the duty of the nurse to provide patients with ethical care they ought to receive during this p articular phase of their treatment.Promoting perioperative nurses safetyIt is therefore another vital job of a perioperative nurse to ensure and create an environment that fosters ethical behavior. As a duty to herself, the nurse must engage in a life-long learning experience, maintaining competence, and promoting personal and professional values, supports the establishment and maintenance of an ethical workplace (Seifert, 2002306). Nurses must be able to establish, maintain, and improve the work environment and maintain an ability to preserve their integrity and moral self respect.Other virtues and excellence of character like loyalty and honesty further promote nurses abilities to fulfill moral obligations and cited as exemplary qualities of the moral person to behave in an ethical manner (ANA, Sec.20). The environment strongly influences in the acquisition of virtues and excellence that may support or impedeethical behavior. Certain policies, procedures and position often help in influencing behavior that can affect the delivery of care. Certain intolerable policies that become inconsistent with a nurse job like mandatory overtime can greatly become an impediment to an employees ethical performance.When nurses are exposed under a strong foundation of ethical practice, standards can positively guide in her performance in the surgical setting. Not only will she be able to identify activities and interventions that help her achieve specific patient outcome but also link her actions t ethical behavior. Most set standards are often based on clinical mandates with virtues of wisdom, honesty, loyalty and courage that are the same qualities of the moral person (AORN, 2002 492). Nurses who are exposed to this professional standard are likely to employ these standards and view them as a normal practice essential to improve unethical and unsafe practices within her responsibility.Providing a therapeutic work setting or enhancing a safe environment will likewise be a c oncern to all perioperative nurses. Potential hazards, risks, and unsafe conditions abound in the surgical arena where constant distractions, excessive noise, hasty reviews of patient records, and frequent interruptions can produce situations where the likelihood of error increases. It is always right to alert physicians and others within the health team of any unsafe or deteriorating patient condition that can lead to an active error like sending the wrong patient for surgery patient morbidity and perhaps mortality. An enlightened approach to this error is to replace blame and punishment with learning and improving (Reeder, 2001117).Facing Ethical DilemmasA nurse, for example, has a statutory duty to report suspected cases of abuse or potential for injury, and this situation may arise when a coworker demonstrates incompetent practice. This is an ethical dilemma facing nurses and it seems that nurses are no closer to a solution of how they can be effective advocates for patients wit hout compromising their working identity or facing conflicts of loyalty (Martin, 1998156). In essence, the nurse would exercise moral alignment with the patient rather than with the physician or the hospital. The nurse will not do any injustice if she takes on the role as the patients advocate in all aspects of health care (Seifert, 2002309). In truth, all health care providers should function as patient advocates (Kohnke, 19802040). In instances such as clarifying consent issues, perioperative nurses may act as advocates in a potential ethical conflict (Spry, 20053). It may be that all cases in which nurses advocate involve ethical action, but not all cases may necessarily involve ethical conflict (Seifert, 2002309).The nurses role in perioperative practice has two components which implies supporting the patients autonomy or his right to choose freely, regardless of whether the nurse is in agreement with the patients decision. One of the fundamental duties of nursing is to promote and defend patients rights (Segesten and Fagring, 1996142). The act of suppressing an individuals rights serves as the catalyst response of the nurse to act as the patients advocate which is her second role. If advocacy implies speaking up for someone, then it is her duty to speak up for the welfare and benefit of the patient. Again, this could be an identifiable problem because not all nurses are comfortable with conflict situations. Others may not recognize any rights violations the nurse may not have a level of experience or communication skills that will facilitate advocacy they may not be empowered as related to a restrictive care environment or they just may not have a level of understanding about advocacy in general (Seifert, 2002308).During an error occurrence during the perioperative phase communication and interdisciplinary relationships is the common cause coupled with disruptive physician behavior institutional responses to such behavior and the effects of such behavior on nurse satisfaction, morale, and retention (Rosenstein, 2002 34). When errors or mistakes do occur, it is imperative that nurses learn what occurred, identify systems gaps that represent latent conditions that can lead to errors, collectively review the causes of the error, and share lessons learned.(Reeder, 2001 118). Unfair, illegal, or unethical practices challenge the creation of a moral environment thus collaboration, fairness, and respect for patients and all members of the health care team are more likely to support fulfillment of ethical obligations(Reeder, 2001118).ConclusionAs an ethical practice, the nurse acts in behalf of the patient, the institution and for herself. This creates confusion particularly when the nurse is faced with a dilemma that conflicts between her personal values and professional obligations (Segesten and Fagring144). Nurses must therefore act in accordance with the practice standards and code of ethics in coordination with her own values. Speaking up in behalf f the perioperative patient suggest that she is favorably acting as the patients advocate particularly during the perioperative phase. This should be viewed as her essential role as a professional and should base her actions according to ethical principle and values. She should speak up when an injustice occurs although in some cases, she would face danger for her actions such as loosing her job. Insofar as ethical practice is concern, an individual must be able to choose whether to sacrifice oneself for her patient and follow a principle of justice. Otherwise if a nurse has any problems with this, she can choose a field that may not compromise her personal beliefs, values or ethics when challenged.The advocacy training for nurses starts within the confines of the nursing education and working environment for the nurse. The philosophy of nursing in which nursing practice stems from supports an individual to promote his/her well-being which is the ethics f practice (Gay lord, 199518). In the nursing school, one must be prepared to identify the ethical issues in patient care and understand the ethical principles and philosophies found in the daily practice and be trained to recognize the patients rights, wishes and care issues (Seifert, 2002312). The knowledge of such ethical principles allows the nurse to stand as an advocate for the patient and speak in his behalf using effective communication skills.Works CitedSpry, Cynthia. (2005). Essentials of Perioperative Nursing (3rd ed.) Aspen Jones and Barlett.Rushton, C., Armstrong, L., McEnhill, E.(1996,June).Establishing therapeutic boundaries as patient advocates. Pediatric Nursing 22, 185-189.Seifert, P.C. and American Nurses Association. (2002, August). Ethics in perioperative practice Duty to self. AORN Journal 76, 306-313.United States. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements, 20.Segesten, K. and Fagring, A. (1996, October). Patient advocacy An essential part of quality nursing care. International Nursing Review 43, 142-144.Gaylord,N. and Grace, P.(1995,March). Nursing advocacy An ethic of practice. Nursing Ethics 2, 11-18.Martin, G. (1998, March). Communication breakdown or ideal speech situation The problem of nurse advocacy. 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