EDITORIAL OPINION

Do We Assume Too Much?

Jan Odom-Forren, MS, RN, CPAN, FAAN

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THIS ISSUE OF the Journal of PeriAnesthesiaNursing ( JoPAN) has several interesting arti-cles and columns. Two of the articles pertain tothe ambulatory surgery patient. One specificallydiscusses how an institution developed guide-lines to address preoperative administration ofpatients’ home medications. In the preoperativesetting, haven’t we often wished for that spe-cific list as we talked to the patient about ap-propriate preoperative behavior? The secondarticle discusses the findings of a nurse re-searcher who talked to patients postoperativelyby telephone. The study focuses on the issue ofpain, but also tells us that patients do not nec-essarily hear and/or understand all instructionsthat are given preoperatively.

A Preoperative Story

I warned my husband last year at the time of hissurgery that he would be excellent fodder foran editorial on the preoperative and postopera-tive behavior of patients. He had to have arepair of his shoulder last December. Preopera-tive education was provided for this very intel-ligent man with a Master’s degree on 2 occa-sions—in the physician’s office and bytelephone the day before the surgery. On theday of surgery, as we were getting ready to goto the surgery center, he told me he was thirstyand thought he would drink some orange juice.“Orange juice?” I asked, slightly panicked, imag-ining either a surgery cancellation or pulmonaryaspiration. “What could it hurt?” he asked. So Itold him, very nicely, “You could aspirate anddie!” (Have you heard that phrase before?) Hestill persisted that he could drink a little and noone would know. Of course, I promptly reas-sured him that, yes, they would know, because

I would inform them. He had to actually pull out

Journal of PeriAnesthesia Nursing, Vol 19, No 4 (August), 2004: pp 225-227

he written instructions to verify that he couldave nothing by mouth that morning.

he next discussion concerned my going withim to the surgery center. Why, he asked, did Ieed to go with him? He didn’t want to incon-enience me and make me wait for him. Heould be fine to drive home, he said. When Inally could close my very open mouth, I ex-lained anesthesia and sedation and why driv-

ng was out of the question. Satisfied that Iidn’t actually mind going with him, the subjectas dropped. Fast-forward to discharge onlyne and a half hours after a successful surgery.e walked into the house, where I sat him in an

asy chair. He seemed very comfortable. I toldim that I was just going to dash to the phar-acy to pick up his pain medication and would

e right back. “Do not move from that chair!”ere my last instructions. When I returnedome 10 minutes later he was in the kitcheneading the mail after walking all the way to theailbox to retrieve it. Fortunately, I didn’t have

o pick him up off the driveway! After 2 days ofnsisting that he do things by the book, I gavep. Of course, that same attitude of self-relianceerved him well in recuperation, and he hasecovered rapidly.

The ideas and opinions expressed in this editorial are thoseolely of the author and do not necessarily reflect the opin-ons of ASPAN, the Journal, or the Publisher.

Jan Odom-Forren, MS, RN, CPAN, FAAN, is a perianesthesiaursing consultant.Address correspondence to Jan Odom-Forren, MS, RN,

PAN, FAAN, 800 Edenwood Circle, Louisville, KY 40243;-mail address: jodom29373@aol.com.

© 2004 by American Society of PeriAnesthesia Nurses.1089-9472/04/1904-0001$30.00/0

doi:10.1016/j.jopan.2004.06.004

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JAN ODOM-FORREN226

Do we assume too much when we teach ourpatients preoperatively? The study on tele-phone calls in this issue of JoPAN discoveredthat patients really did not understand some ofthe issues that they were taught preoperatively.Are we giving the patients instructions, but notexplaining the rationale? Are we not tailoringour teaching to the needs of each patient? Dowe do the basics and assume that our patient isgoing to follow our instructions without ques-tion?

There is responsibility on both sides. We, asperianesthesia nurses, have a responsibility toeducate our patients. At the same time, ourpatients have a responsibility to give us accurateinformation and follow instructions. But, dothey understand that? Do we need to havepatients sign contracts assuming responsibilityfor following instructions? Here are certainlysome study questions of interest to you nurseresearchers out there! I believe that we shouldperform our preoperative education with noassumptions. We need to start at the beginningand build the rationale for following instruc-tions regardless of educational level or the ageof the patient. We, as nurses, can only controlour half of the equation. We have to give thebest information possible to assist with follow-through for the patient.

More Assumptions

Two of our columns in this issue caused me tothink more about assumptions. I always as-sumed PACU nurses were very compliant withhandwashing. It is true that nurses are morecompliant than other health care workers. Onestudy showed that the health care workers mostat risk not to follow hand hygiene recommen-dations were physicians and nursing assistants.1

Being a nurse, however, is obviously notenough, because another risk factor was simplyworking in an intensive care setting.

As we read the columns on handwashing by anesteemed anesthesiologist and our own re-

source columnist, we have to ask how it per c

ains to our own nursing practice. I cer-ainly remember caring for one patient andunning directly to another patient who hadrespiratory arrest. The Centers for Diseaseontrol (CDC) and other organizations thatave an interest in infection control arerying to modify those risk factors that cane changed. Our work setting, eg, theACU, cannot be changed, but the ease ofashing our hands or provision of an easierethod may be a place to start. The CDCas approved the use of alcohol-based handub and many settings have already insti-uted that product at the bedside. Now, it isur responsibility to actually use it and use

t appropriately to decrease transmission ofnfection. The CDC report states that,. . . whether increased education, individ-al reinforcement technique, appropriateewarding, administrative sanction, en-anced self-participation, active involve-ent of a larger number of organizational

eaders, enhanced perception of healthhreat, self-efficacy, and perceived socialressure or combinations of these factorsan improve HCWs’ adherence with handygiene needs further investigation. Ulti-ately, adherence to recommended hand-ygiene practices should become part of aulture of patient safety . . .”2

nd There’s More

his issue of JoPAN contains a Continuing Edu-ation article that discusses a case study onevelopment and management of methemoglo-inemia. This is a rare, but serious complicationhat can affect our perianesthesia patients andhould be of interest to all. Our Accreditationolumn discusses abbreviations that should note used in the health care setting for patientafety reasons and the column on Pain Careiscusses pain assessment for the PACU nurse.here is also a section that includes abstracts

rom the national conference: research posters,

linical practice posters (Celebrate Successful

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DO WE ASSUME TOO MUCH? 227

Practices), and national conference presenta-tions.

We here at JoPAN have assumed that our read-ers are interested in all aspects of care for theperianesthesia patient. I know in this instance

that we have not assumed too much! r

eferences

1. CDC. Guideline for hand hygiene in health-care settings.vailable at http://www.cdc.gov/mmwr/preview/mmwrhtml/r5116a1.htm#box1. Accessed June 23, 2004

2. CDC. Guideline for hand hygiene in health-care settings.vailable at http://www.cdc.gov/mmwr/preview/mmwrhtml/

r5116a1.htm. Accessed June 23, 2004