Sharing the stories of perioperative nursing

AORN Journal, Nov, 2005 by Sharon A. McNamara

In past "President Messages," I have communicated my thoughts through songs, dance analogies, poems, quotes, and pictures, but this column is all about you, the AORN members. Perioperative Nurse Week is Nov 13 to 19, and my theme is "Vital to Care, Knowledge to Share." My goal for this column is to assist you in sharing your perioperative nursing story and celebrating that story of caring with others.

When I was pursuing my master's degree, I had to write a thesis. I chose to do a qualitative, descriptive study using the conceptual framework of Jean Watson's theory of nursing' to examine the caring dimensions of perioperative nursing practice. I knew in my heart that perioperative practice is not just technology based; caring is at its core. My research found that perioperative nurses do practice caring and that the essential structure of caring described by the participants was the establishment of a human, care relationship and provision of a supportive, protective, or corrective psychological, physical, and spiritual environment. Thank you to Chris, Michele, Joan, Paula, and my two anonymous nurses. Listening to these nurses describe their experiences, I learned to tell my story. This experience whetted my appetite for perioperative nursing stories.

ONE EXAMPLE OF CARING

Let me share with you how this message's theme of sharing knowledge through stories came to me. AORN made arrangements for a television news crew to come to WakeMed Hospital, Raleigh, NC, to film a piece on medication safety for network sweeps week coverage in November. I had the news crew in the OR, and the photographer was taking pictures of the nurse and surgical technologist preparing and labeling medications at the back table in preparation for the patient's arrival. At this point, the patient was brought into the room and transferred to the OR bed. While anesthesia personnel connected the patient to the various monitors, the circulating nurse was busy policing the news crew. I stepped to the patient's side and began to explain what was happening. I had met the patient earlier in the preoperative area, and now he was becoming anxious. I took his hand and explained that the surgeon was delayed a few minutes, but we would keep him comfortable and wait together. He relaxed immediately.

At this point, I realized that the photographer had moved his camera to my side of the bed and was taking a picture of my hand and the patient's hand joined together. No directions had been given, but this media person immediately honed in on the difference being made in that room by one nurse who assessed the patient's anxiety, educated the patient about what was happening, and comforted the patient with the information that they would wait together, holding hands. The visual symbol of that nursing expertise was the holding of the patient's hand, and the photographer pointed it out to everyone with his camera. This is what we should celebrate; this is the difference we make as perioperative nurses.

TELLING OUR STORIES

One of your Board members, Ric Cuming, RN, MSN, CNOR, CPAN, has a wonderful way of discovering perioperative nurses' stories. When Ric asks, "What did you do today?" he does not expect that you will answer "a laparoscopic cholecystectomy," or "spinal fusion" or "a total hip arthroplasty." Ric wants you to tell him what you really did. For example,

   I managed the care of my
   patient by initiating a
   time out for the surgical
   team to ensure that we
   had the correct patient,
   procedure, side, and site,
   and the proper position,
   implants, and equipment
   for the patient's planned
   procedure. I labeled all
   medications on the surgical
   field to guarantee that
   the patient received the
   right medication for the
   right reason. I prepared
   and gave the prescribed
   antibiotic within the one-hour
   time frame before
   incision, and I remained
   alert to breaks in aseptic
   technique for all team
   members to prevent surgical
   site infection. I prevented
   neurological, vascular,
   and respiratory
   complications through the
   use of proper positioning
   and padding. I protected
   the patient from potential
   burns or fire by assuring
   that the prep solution was
   dry and the drip towels
   were removed before draping.
   I maintained the
   patient's normothermia
   throughout the procedure
   and into the recovery
   phase to promote better
   healing.

These are only a few of the safety measures you initiate daily as a patient advocate. They may seem to be merely technical functions, but if they are not done while you astutely assess every movement and provide a gentle caring touch, patient injury can result.

What story would you tell about meeting the psychological needs of a patient? Did you arrange for an interpreter so that your nonEnglishspeaking patient and his or her family members could fully understand what was going to happen throughout the surgical experience? Did you provide the patient with time to meet with a clergy person or take a minute to pray with the patient or say a silent prayer? Were you present and attentive to this patient throughout the procedure? Did you allow the patient to have family members present as much as possible in the preoperative and postoperative areas? Did you protect the patient's dignity by keeping doors closed, windows covered, and ancillary personnel out of the room when the patient was exposed? Did you respect the patient's privacy by using his or her personal information discreetly? These are all behaviors that demonstrate how you value the patient as a unique human being.