Tailoring Care to Adolescent Surgical Patients: New Nursing Model

The Adolescent Perioperative System Stability Model can help perioperative nurses tailor care to the unique needs of 18 to 21 year old patients, according to an article in AORN Journal.

Surgery can be a stressful experience at any age — about 80 percent of surgical patients develop stress and anxiety prior to surgery, and stress can lead to less-than-optimal perioperative experiences. Adolescents, however, perceive different things as stressful.

"The perioperative experience is different for adolescents than for adults or children," wrote Janean Carter Monahan, PhD, MS, in part because of the cognitive, emotional and physical changes they are going through. For example, adolescents have heightened self-consciousness, concerns about privacy and loss of confidentiality, and a developing need to feel in control.

Dr. Monahan detailed a new nursing model, the Adolescent Perioperative System Stability Model, based on the Neuman Systems Model of nursing, which examines stress and the patients' reaction to it. The new model provides interventions specific to adolescents for all phases of perioperative care. A basic summary of those interventions are below.

Preoperative phase
In this phase, nurses should educate patients about the procedure and the environment to ease anxiety and fear, such as explaining what to expect from anesthesia. Perioperative nurses should also encourage and answer any patient questions.

Intraoperative phase
Nurses should continue to act as the patient advocate during this phase of surgery. This includes introducing the patient to the entire surgical team. They can encourage a sense of patient control by offering him or her a warm blanket, making it a choice if the patient takes it or not. As the patient is emerging from anesthesia, the nurse can act as an advocate by keeping noise levels low, "which allows the nurse to monitor for problems such as mergence delirium."

Postoperative phase
As with the other phases of surgery, nurses should explain all events to the patient, encourage questions and offer choices whenever possible, such as asking if the patient would like a parent or visitor to be present. This phase is also when nurses should discuss any activity or dietary restrictions and provide a recovery timeframe so the adolescent knows what to expect.

Overall, "the perioperative nurse must be respectful and allow [the adolescent] to make decisions when appropriate," Dr. Monahan wrote. "The nurse must also be nonjudgmental and endeavor to ensure the patient's privacy and confidentiality."

By using the Adolescent Perioperative System Stability Model as a guide, nurses can address the unique needs of the 18 to 21 year old age group and make the perioperative experience a positive and successful one.

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