Hemodynamic Instability Following Major Surgery: Early Nursing Assessment and Intervention Outcomes: A systematic Review

Background: After performing a major surgery, patients can experience a range of consequences, some of which can be pronounced and contraindicate any additional treatment. Early nursing assessment and Intervention is one of the initial points of contact for evaluating and addressing this complication. This is usually carried out by the nursing staff. Aim: The aim of this systematic review is to assess and quantify the impact of nursing assessment and intervention in the early detection of hemodynamic instability after significant surgical procedures. Methods: Following the PRISMA 2020 guidelines, a systematic review of pertinent literature published after 2000 within the databases of PubMed, CINAHL, the Cochrane Library, Scopus, and Embase was conducted. The searches were limited to primary studies that focused on adult populations after having undergone a major surgical procedure and that examined nursing assessment/ intervention protocols. Following this dual screening process, ten studies were selected for the final analysis. Findings: Nursing interventions involve assessments through the use of Early Warning Scores and ongoing assessment and monitoring to improve detection and escalation. Nurse-led interventions can include the use of hemodynamic devices (and other nursing protocols). This has promoted hemodynamic stability in patients, decreased length of hospital stays, and decreased complications without an increase in adverse outcomes. Qualitative data showed that nurses were encouraged to use their clinical judgement. Overall, coaching and mentoring were given to the nurses and the results were positive and less ICU utilization was reported with the appropriate management of ICU bed availability. Overall, the use of monitoring devices was a welcomed improvement and reduced the incidence of alarm fatigue. Conclusion: Engaging in early assessments and interventions in nursing is effective in decreasing postoperative Hemodynamic instability in patients as well as improving their outcomes. Further strengthened training, multidisciplinary team support, and standardized protocols for nursing are encouraged.