Overview of the Surgical Experience

Core Concepts

The three perioperative phases

• Preoperative phase — from the decision to have surgery through arrival in the operating room. Nursing focus: assessment, preparation, education, verification (consent, NPO status, allergies, identity), and emotional support. This phase is covered in depth in Chapter 25: Preoperative Care.
• Intraoperative phase — from arrival in the OR through closure of the incision and transfer to recovery. Nursing focus: maintaining the sterile field, monitoring the anesthetized person, positioning, preventing injury and hypothermia, counting instruments and sponges, and advocating for a person who cannot speak for themselves. This chapter focuses on this phase.
• Postoperative phase — from the end of the procedure through recovery, both in the postanesthesia care unit (PACU) and on the nursing unit. Nursing focus: airway and circulation surveillance, pain management, wound and drain care, early mobility, and discharge teaching. See Chapter 27: Postoperative Care.

Classifying surgery

Surgery is described three ways, and the descriptions overlap:

• By purpose: diagnostic (to find out what is wrong, e.g., a biopsy), curative (to remove disease, e.g., removing a tumor), restorative or reconstructive (to repair or improve function or appearance), and palliative (to relieve symptoms without curing the disease).
• By urgency: elective (planned, can be scheduled at a convenient time), urgent (needs to happen soon but not immediately — for example, within days), and emergency (immediately necessary to preserve life, limb, or organ function).
• By invasiveness: open surgery (through an incision) versus minimally invasive approaches (small incisions with instruments and cameras, such as laparoscopy or endoscopy). Minimally invasive approaches generally mean smaller wounds, less tissue trauma, and shorter recovery, though they are not right for every situation.

The surgical team and its roles

A typical surgical team includes the surgeon, the anesthesia provider (an anesthesiologist or certified registered nurse anesthetist, CRNA, depending on the setting — managing anesthesia, pain, and physiological status during the case), the circulating nurse (an RN who manages the non-sterile OR environment, documents, coordinates, and advocates for the patient), the scrub person (a nurse or surgical technologist who works in the sterile field preparing and passing instruments), and often additional assistants, technicians, and students. Postoperatively, the PACU nurse receives the person and manages emergence from anesthesia. Everyone has a defined role — and the roles depend on each other.

The OR environment

The operating room is a controlled environment built around infection prevention and safety: a defined sterile field (the microorganism-free area where the procedure happens), restricted traffic patterns, controlled temperature and humidity, and specialized equipment such as electrosurgery units, suction, lighting, and monitors. The environment is deliberately structured — even movement in and out of the room follows rules that protect the sterile field.

The person at the center

Through all the phases, the person — not the procedure — is the focus. Surgery is stressful, and anxiety is normal. The person's values, preferences, questions, and support system travel with them. Part of every nurse's role in every phase is advocacy: keeping the person informed, comfortable, respected, and safe — even when, intraoperatively, the person is asleep and cannot advocate for themselves.

Common Confusions