Dont just talk about it. Do it.
Nancy L. Mehaffy, RN
Nurses such as Geneva Sharp, RN, (author of Two-way Street) know their worth as operating r o o m nurses and their role in the tatal pa- tient-care program. The opportunity for them to have this experience of patient contact has provided many benefits to the patient, the hospital, the doctor-and to the nurses them- selves.
I have attended several workshops and lectures where preoperative teach- ing was discussed. I have been able to sw the value of such programs, but I procrastinated for some time in start-
Nancy L. Mehaffy, RN. i s operating room ruper- visor, Martin Luther Hospital, Anaheim, Calif. She was educated a t the Burlington Hospital School of Nursing, Burlington, Iowa, and worked there as a staff nurse. Mrs. Mehaffy, who i s a member o f the National AORN Editorial Committee, has had ex- perience as a staff nurse in the head specialties operating room and head nurse in oral surgery a t the University of Iowa Hospital, Iowa City: and in private practice with C. M. Kos, MD, an Iowa C i t y otologist. She i s president-elect of AORN of Orange County, Calif.
ing them, because of the usual excuses an OR supervisor has: staffing; its new; physicians acceptance; nurses acceptance. I gathered information and f m e d an outline for the proce- dure, but still it remained on my desk-semif orgo tten !
Then I attended an AORN meeting where the topic d a panel discussion was preoperative teaching. A surgeon, an anesthesiologist and an OR super- visor spoke, emphatically, about the need for such a program for every pa- tient who enters the OR. They im- pressed me. I made the decision to get with it.
The program was met With a vari- ety of reactions - some enthusiastic, some reluctant, some people appeared disinterested because they didnt like patient contact. We discussed it at length and decided to start our pro; gram by conducting informal patient visits. We had an outline to follow- this was to give us confidence, if sud- denly our minds went blank.
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We periodically review our pre gram with participating RNs to share experiences and ideas. We have&- cussed different staffing patterns, but it seems it is best for us to have one registered nurse on preoperative rounds for one week. She comes on at 8:30 am, relieves circulating nurses for breaks and lunches and visits pa- tients in between, and still has time for helping when needed in the OR.
We would like to have the circulat- ing nurse see the patients she will have in her room the next day, but it doesnt work out that way in our OR, because the nurses who work 7 am to 3:30 pm are usually circulating on cases all day; and when the pa- tients are admitted, these nurses are finished with their eight-hour shift.
If their schedule finishes early af- t e r n m , this works nicely. Sometimes the nurses visit patients they have had in their m m s postoperatively. Patients enjoy this a t ten t iomven if it is just for a minute.
Our recovery room nurses also at- tempt to visit as many patients as possible, to explain RR and p t o p e r - ative procedures. If they dont have the opportunity, the OR nurse relates this, because all of our operating room nurses accasimally work in the mavery mom and are up on the procedures there.
Before starting our program, we received administrations enthusiastic approval. We then informed the Sur- gical Committee and they also felt it would be a beneficial program.
We knew, if we were going to see all patients, we were going to need the cooperation of the admitting de- partment and the surgical floors. Ad- mitting was told of our plan, so they
could understand the i m p o ~ of early admission of surgical patients. They developed a new system of ad- mission, giving each surgical patient an appointment time for admission. Surgeons assisted by urging their pa- tients to come in for admission early and they also discharged patients earlier in the day to a b l e the rcwrm to be ready far new arrivalsl We still have a few late arrivals, but most of our surgical patients are seen pre and postoperatively.
The results are good and numerous. The comments we have received from patients, nurses on the floor, and doc- tors are most gratifying. Our hospital sends questionnaires to each patient after discharge, regarding their opin- ions on such things as the quality of hospital care.
We have had may comments di- rected to our department from happy patients who, as they stated, were overwhelmed by this visit from the OR nurse. Most have stated they felt more comfortable about their visit to the operating room, more understand- ing and less fearful of the unknown, cold, sterile world of the OR.
It now seems to be a w a r m e r , friendlier, and more understanding place in which to experience operative procedures. Many patients who had previously experienced many opera- tive p r d u r e s and would be ex- pected to be more knowledgeable, still said this was one of the greatest pa- tient-care advances they had n o t i d . They were most appreciative.
Our physicians tell us many of their patients comment to them about these visits. They say they are glad some- one cared enough to talk to them; and more important, to listen to them- and understand their feelings.
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Most of the RNs were gratified to see and hear results; and they feel more comfortable each time it is their turn to visit patients. They recognize their place in the total patient-care p ic ture tha t an OR nurse is very in- strumental in that high quality care we are all seeking to give.
I appreciate nurses who attempt something new and who have keen minds which see the need for this type of care. If they then share their thoughts with others, those of us who are interested in impraving patient care can get with it-not just talk about it.
From my viewpoint, as a super- visor, I can readily see the reasons for instituting this program have proven justified.
It has helped to eliminate the de- personalization of both patient and nurse, by allaying patients fears of the unknown.
It has provided continuity d pa- tient care for the surgical patient.
It has helped the nurse be aware d herself as a teacher; and has gotten her away from just the technical em- phasis of patient care.
The nurses now have more interest in total care; and they have an in- creased sensitivity to patients as in- dividuals, n o t merely procedures. More coordination of care with floor nurses has developed; and lastly, the program is helping provide the hi&- est quality nursing care to the patient.
This is a prime goal at our hospital -and yours, too. 17
When in doubt . . . do! Nurses must render whatever heroic assistance they can, consistent w i th experience and training, when faced w i th an emergency situation, according to W i l l i a m Andrew Regan, edi tor , Nursing Idw.
This i s one situation, said the edi tor of the publ icat ion geared to informing nurses about legal matters, when the pr inciple When in doubt, do nothing, does no t apply.
Ac t ionab le negligence can result f rom malfeasance or misfeasance, said Regan, and this results f rom do ing something in a negl igent manner. There i s another fo rm o f negligence, how- ever, which results f rom fai lure t o d o something which should have been done in a given s i tuation.
There is a reasonable l im i t to emergency action. said Regan. For example, anyone (nurse or other person) can do anything redsondble calculated to save the l i f e o f another. The legal key i s the reasonableness of the measures taken. I n addi t ion, the professional nurse i s expected t o br ing to bear, in any emergency situation, the sum to ta l o f her experience, mature judgmeni and skil l i n on e f fo r t to forestal l t he emergency and sustain the pat ient un t i l addi- t ional professional assistance arrives t o take over the c l in ical responsibility.
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