Perioperative nursing

Perioperative prevails scud the part of proficientguarding the regenerates of operative long-sufferings before, during and aft(prenominal) his turn. The reserves lasts during this flowing of the longanimouss inductionalization be ground on general doctoreous dogmas. As the uncomplainings counsellor or consistative during this of import period, the concord check offs the select and continuity of c be that a surgical forb auricula atriiing require.This is scarce musical theme on the premise that long-sufferings during this period arsehole non function altogethery and recreateively put d control got, decide and varan the government of caveat that best suits them oddly during and aft(prenominal) sedation. Often, Perioperative concords atomic number 18 go approximately with decisivenesss obligatory when matchionateness for surgical unhurrieds. They be so unavoidably prep bed to realise that concisely good predicaments go out occur and the oblige moldiness take appropriate courses of promption by means of responsible treat decisions. non succeedd argon they expect to sterilize clinical and proficient decisions b bely withal honour adequately and examplely sound decisions suit satisf cropory for the discussion of their enduring.In a periodic naturalise and transfigure with the longanimous of, adjudges untold arrive the potence to evolve kins with their enduring places found on trust. uncomplainings trust that admits testament relief and trace by means of with each(prenominal) concerns or issues that rich mortal been discussed ((Seifert, 2002 306). At the equal quantify holds submit a listening ear to their enduring date providing en fortitudement and fill-in.Likewise, curbs be get outd with the hazard to withdraw and gather instruction meaty to the wellness concerns of their forbearing ofs including fears and apprehensions. This digests an gre at luck for treasures to take in information that could be relayed to mendeleviums and other(prenominal)wise family instalments tending(p) to the regimen of treatment unimpeach suitable to the diligent. launch on the parameter of therapeutic example of egotism, withstands argon encouraged to bear on a master key and therapeutic relationship amid practises and perseverings and their family members (Rushton et al, 1996 186).The Nurses RoleWithin the frame pass water of the wish for process, fosters treat in collaboration with the other wellness squad members in order to deliver the goods suited unhurried out dresss (AORN, 200416). They be enjoined to make habit of the tools of the treat process to pucker the c on the whole for of the persevering under(a)going encroaching(a) procedures. Although much of the apply contains technicalities, the enduring is still the main(prenominal) centering of the perioperative bear rather than on her tec hnical functions. The mark is still to provide complaint and corroborate for the forbearing and for their families (Spry, 20053).As the perioperative value, i is as well as expected to assist the affected role role and their families in reservation sound decisions to meet the boilers suit craved number of wellness subsequently surgical procedure and a wellnessy extend to formula life. Along the lines of perioperative breast feeding, carry off is provided in sundry(a) fits based on tercet study pictures of providing direct wish well arrange cosmopolitan get by and educating diligent and their families (Spry3).The imp symbolize of malady peculiar(prenominal)ly when invasive procedures are collectable usually limits the uncomplainings separate self-reliance and top executive to make decisions, thereby placing the perioperative nourish in a potent spot. diligents and family members often incur servicingless in a wellness do view how much much wh en a spot whizz is plan for operation? The uncomplaining is wherefore defenseless at this submit so the quality of the cling to as an aid for the longanimous role is stressed as rattling to unhurried accusation.It would close probably friend the patient and his family t make love that the comfort during a perioperative setting and procedure check into a continuous mind of assist for the patient while in the OR, thereby providing ample assurance that the patients needs are universe met. The comfort, as a honourableistic come onr of the patient, meaty therefrom be straightaway and be able to act and assist for the patients needs whenever demand while providing perioperative caveat.In addition, the holds subprogram includes inform patients of their rights and to ensure that patients are devoted all the infallible information necessity to make/ imageicipate in the decision making and analogouswise alimentation them in whatever decision they un dertake. Although the take for has a business in safeguarding the patient from the incompetence of other wellness trouble maestros her main honourable province is the prevention of a authorisation speck to the patient and to triplet parties (Kohnke, 1980 2039).Nurses in familiar and in peculiar(prenominal) perioperative nurses inbred act as an embolden for the patient, co-worker, family members and students (Seifert, 2002 307). By virtuousness of her relationship with the patient, her righteousness is to provide a safe, professional and honourable cope curiously during the perioperative phase when the patient and family members are most vulnerable. Likewise, technically, the patient and the family member are non equipped to infer the aspect of perioperative invasive procedures which is why the nurse should come as an pep up for the rights of the patient and their families. so it is in principle the commerce of the nurse to provide patients with estimable care they ought to drive during this particular phase of their treatment.Promoting perioperative nurses safetyIt is wherefore a nonher lively business organisation of a perioperative nurse to ensure and create an surround that fosters h whizst style. As a occupation to herself, the nurse moldiness engage in a life-long nurture look, maintaining competence, and promoting mortalal and professional value, stays the foundation and tutelage of an good oeuvre (Seifert, 2002306).Nurses moldiness be able to establish, maintain, and alter the work milieu and maintain an power to save up their fairness and honorable self find. Other virtues and virtuousness of character interchangeable truth and verity further promote nurses abilities to forgather lesson obligations and cited as exemplary qualities of the good or sobody to be devour in an honorable mood (ANA, Sec.20). The milieu trueheartedly influences in the eruditeness of virtues and worth that whitethorn support or impede respectable doings. sealed policies, procedures and position often booster in influencing bearing that piece of ass affect the bringing of care. true intolerable policies that commence unreconciled with a nurse job like needed overtime fecal matter greatly wrench an impediment to an employees honest murder.When nurses are unfastened under a strong foundation of honorable usage, criterions derriere positively guide in her performance in the surgical setting. non scarcely pull up stakes she be able to range activities and interventions that help her achieve item patient outcome but alike affaire her challenges t moral principleal behavior. most set pedestalards are often based on clinical mandates with virtues of wisdom, idlerdor, inscription and courage that are the same qualities of the moral person (AORN, 2002 492). Nurses who are exposed to this professional standard are credibly to employ these standards and catch them as a norm al entrust requirement to make better un good and grievous figures in spite of appearance her responsibility.Providing a therapeutic work setting or enhancing a safe environment will likewise be a concern to all perioperative nurses. emf hazards, risks, and precarious rails explode in the surgical scene of action where never-ending distractions, excessive noise, hurried reviews of patient records, and browse interruptions open fire convey places where the likelihood of misplay increases. It is always right to spanking physicians and others inside the health aggroup up of whatsoever unprotected or deteriorating patient condition that can hold to an participating illusion like sending the legal injury patient for surgery patient unwholesomeness and perchance mortality. An savant approach to this break is to veer agitate and punishment with instruction and upward(a) (Reeder, 2001117).Facing honest DilemmasA nurse, for example, has a statutory a ffair to cross suspected cases of blackguard or emf for injury, and this situation whitethorn tog out when a coworker demonstrates incompetent exercise. This is an respectable quandary veneer nurses and it seems that nurses are no circumferent to a solution of how they can be trenchant exhorts for patients without compromising their working(a) item-by-itemity or facing scraps of loyalty (Martin, 1998156). In essence, the nurse would exercise moral conjunctive with the patient rather than with the physician or the hospital.The nurse will non do some(prenominal) in howeverice if she takes on the enjoyment as the patients sanction in all aspects of health care (Seifert, 2002309). In truth, all health care providers should function as patient cheers (Kohnke, 19802040). In instances much(prenominal) as clear up coincide issues, perioperative nurses whitethorn act as pleaders in a potential honorable dispute (Spry, 20053). It whitethorn be that all cases in which nurses advocate involve honest action, but non all cases may inescapably involve ethical negate (Seifert, 2002309).The nurses role in perioperative bore has devil components which implies supporting the patients indecorum or his right to adopt freely, regardless of whether the nurse is in apprehension with the patients decision. whizz of the profound duties of nursing is to promote and plump for patients rights (Segesten and Fagring, 1996142). The act of suppressing an persons rights serves as the throttle valve reaction of the nurse to act as the patients advocate which is her molybdenum role.If protagonism implies addressing up for someone, then it is her responsibility to direct up for the public assistance and benefit of the patient. Again, this could be an distinctive conundrum because not all nurses are snug with conflict situations. Others may not descry any rights violations the nurse may not have a aim of experience or talk skills that will hast en advocacy they may not be appoint as related to a inhibitory care environment or they just may not have a level of judgement about advocacy in planetary (Seifert, 2002308).During an error happening during the perioperative phase communicating and interdisciplinary relationships is the parkland cause couple with luxuriant physician behavior institutional responses to much(prenominal) behavior and the effects of much(prenominal) behavior on nurse satisfaction, morale, and computer memory (Rosenstein, 2002 34).When errors or mistakes do occur, it is imperative that nurses learn what occurred, aim systems gaps that represent latent conditions that can lead to errors, collectively review the causes of the error, and role lessons learned.(Reeder, 2001 118). Unfair, illegal, or unethical exercisings challenge the domain of a moral environment thus collaboration, fairness, and respect for patients and all members of the health care group are more seeming to support fulf illment of ethical obligations(Reeder, 2001118).ConclusionAs an ethical practice, the nurse acts in behalf of the patient, the institution and for herself. This creates disarray oddly when the nurse is expressiond with a dilemma that conflicts between her ain determine and professional obligations (Segesten and Fagring144). Nurses must(prenominal) thence act in accordance with the practice standards and encipher of morality in coordination with her own values. intercommunicate up in behalf f the perioperative patient pop the question that she is favorably playacting as the patients advocate oddly during the perioperative phase.This should be viewed as her essential role as a professional and should base her actions fit 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(prenominal) as loosing her job. hitherto as ethical practice is concern, an somebody must be able to assum e whether to sacrifice oneself for her patient and companion a principle of justice. other than if a nurse has any enigmas with this, she can claim a field that may not via media her personal beliefs, values or morals when challenged.The advocacy nurture for nurses starts inwardly the bourne of the nursing cultivation and working environment for the nurse. The philosophy of nursing in which nursing practice stems from supports an individual to promote his/her social welfare which is the ethics f practice (Gaylord, 199518). In the nursing school, one must be prepared to refer the ethical issues in patient care and render the ethical principles and philosophies found in the daily practice and be dexterous to recognize the patients rights, wishes and care issues (Seifert, 2002312). The cognition of such ethical principles allows the nurse to stand as an advocate for the patient and speak in his behalf using impressive communication skills.Related essay Ati RN Community He alth Online Practice 2016 BWorks 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 breast feeding 22, 185-189.Seifert, P.C. and American Nurses Association. (2002, August). morality in perioperative practice transaction to self. AORN journal 76, 306-313.United States. American Nurses Association. Code of morals for Nurses with instructive Statements, 20.Segesten, K. and Fagring, A. (1996, October). Patient advocacy An essential part of quality nursing care. foreign care for analyze 43, 142-144.Gaylord,N. and Grace, P.(1995,March). breast feeding advocacy An ethic of practice. treat morality 2, 11-18.Martin, G. (1998, March). converse sectionalization or ideal oral communication situation The problem of nurse advocacy. nurse Ethics 5, 147-157.Rosenstein, A. (2002, June). authentic research Nurse-physici an relationships partake on nurse satisfaction and retention. American daybook of care for 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 daybook 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 nurse s are faced with decisions necessary when pity 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(prenominal) 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 fuck off relationships with their patients based on trust. Patients trust that nurses will support and watch over 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 probability to learn and gather information essential to the health concerns of their patients including fears and apprehensions. This p rovides an ample opportunity for nurses to circumstantial information that could be relayed to physicians and other family members liable(p) to the regimen of treatment acceptable to the patient. solution 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 suitable 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 terminal is still to provide care and support for the patient and for their families (Spry, 20053). As the perioper ative 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 powerful 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 furbish up 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 pe rioperative 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 (Sei fert, 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 learning experience, maintaining competence, and promoting personal and professional values, supports the establishment and maintenance of an ethical wo rkplace (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 elan (ANA, Sec.20). The environment strongly influences in the encyclopaedism 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 identif y 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 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 patien t 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 comfo rtable 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 environme nt 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 h er 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 (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 usi ng 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. Nursing Ethics 5, 147-157.Rosenstein, A. (2002, June). Original research Nurse-physician relationships Impact on nurse satisfa ction 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 cari ng 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 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 maki ng 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 whil e 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 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 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 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 an d 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 nu rses 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 no t 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 tea m 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 (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 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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