urgery is potentially anxiety producing for any patient. Professional registered nurses use a myriad of approaches to decrease this anxiety. Nurses on the units tell the patient what he may expect preoperatively, intraoperatively, and postoperatively, and some operating and recovery room nurses visit the patient to provide additional explanation about what he will experience in the operating room and recovery room. The patient now has information, but who helps him assimilate these facts. When, how, and where can this happen? A surgical reception ares provides the opportunity for the registered nurse to assist the patient to incorporate this information while acting as his advocate and providing continuity of care from the preoperative to the postoperative period. The nurse does this by reinforcing previous teaching, by utilizing the nursing process, and by applying the problem-solving approach to nursing care. At Madison (Wis) General Hospital, the surgical reception area is a quiet, dimly lit room 21 ft by 21 ft. It is adjacent t o the operating suites and recovery room, which are located on the same floor as the one-day surgery and the surgical waiting room where the family and friends of surgical patients may wait. A patient is transported from his room via stretcher to the surgical reception or holding area where he is greeted by the registered nurse. After checking the patient’s identification band, the nurse verifies the information on the preoperative checklist that was completed before the patient was transported to surgery. He or she asks the patient when he last ate, drank, and voided, omitting the last question if the patient has a retention catheter. The nurse makes certain that the patient has removed jewelry, hairpins, den-

S

Nursing care in the surgical reception area Edwina A McConnell, RN

Edwina A McConnell, R N , is assistant director, surgical nursing at Madison (Wis) General Hospital. She has a BS from Boston University School of Nursing and a master’s degree in nursing from the University of Colorado, Denver.

AORN Journal, June 1978, V o l 2 7 , No 7

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An OR transporter brings the patient to the operatingroom, where he waits in the holding

area. Since this patient will be having a local anesthetic, the nurse in the holding area checks his vital signs. The circulating nurse transports the patient from the holding area to the operating room.

tures, nail polish, and makeup and asks if he is wearing any prostheses. The patient’s condition prior t o leaving the unit is documented on the checklist and the nurse compares the patient’s present condition with h i s earlier status. If the physician ordered antiembolism stockings for the patient preoperatively , the nurse ascertains that the patient is wearing them. Now, the nurse examines the chart for completeness, using questions on the preoperative checklist as a guide. For example, does the chart contain a history and physical and a note by the surgeon? Is the surgical consent form cor1316

rectly completed and appropriately signed? Are the results of the CBC (complete blood count) and urinalysis on the chart? And, if blood has been ordered, how many units are available? Any omissions in the above information may delay surgery. Thus, the nurse immediately follows up any missing data. Occasionally a patient arrives in the reception area and although information on the checklist has been initialed as done, the action has not been completed. For example, according to the preoperative checklist, a patient’s rings have been removed, but the patient is still wearing them. The nurse

AORN Journal, June 1978, Vol27, No 7

telephones the nurse on the unit who signed out the patient and requests that he o r she correct the matter. The nurse in the surgical reception area also checks the vital signs of any patient whose surgical procedure is to be performed under local anesthesia. The nurse compares the readings he or she obtains with those recorded on the unit and notifies the surgeon of any significant deviations. After verifying information on the checklist and taking the patient’s vital signs, if appropriate, the nurse stamps the patient’s name on forms that will be completed during surgery.

As patient advocate, the nurse astutely observes and carefully listens to patients. He or she listens for the fear or apprehension in the question behind the question or in the casual comment. By being aware of and acknowledging the patient’s anxieties, fears, and questions, the nurse may be able to reassure him honestly, thus enabling him to face surgery more calmly. Questions patients frequently ask include, “Why is it so dark in here?” “Where will I wake up?” “Why is my mouth so dry?” “How long will I be in surgery?” and “Why did I have to remove my jewelry and makeup?”

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Preoperative teaching guide MADISON GENERAL HOSPITAL Madison, Wisconsin

Discuss the following with your patient and his family. Indicate date and your signature after completion.

I date time

I. Preoperative period A. Food and fluid restricted NPO sign means nothing by mouth B. Sleeping pill to insure rest

C. Showerltub bath and prep before surgery D. Preoperative medication (“hypo”) one hour before surgery Not induce sleep but aid in relaxation 0 May experience dry mouthidrowsiness Remain in bed, quiet after E. Transported to and from OR accompanied by OR staff F. Information for the family 0 May visit relative morning of surgery before he goes to operating room 0 If operation scheduled for 8 am, leave unit at 7:15 am 0 May wait in waiting room (4 Center) or in patient’s room 0 Inform unit secretary if the family leaves the floor, eg, to go to lunch, etc II. lntraoperative period A. “Holding Area” - dimly lit special area near operating room where patient remains until surgeon is ready 0 OR staff in attendance, patient is not left alone 6.Recovery Room (PAR) - brightly lit area where all patients having a general anesthetic go to after surgery until awake and reacting 0 Vital signs checked frequently 111. Postoperative period- Indicatein blank providedexplanationgiven to patient A. Postoperative regimen 1. Diet 2. Activity 3. Special treatments or checks 4. Restrictions, if any 5. Exercises: breathing - - extremities 6. Specialized instructions for patient 7. Pain medication IV. Fears, misconceptions, or need for more information expressed ~

V. General response to teaching; cooperation with demonstration

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AORN Journal, June 1978, Val 27, No 7

initial

Preoperative checklist MADISON GENERAL HOSPITAL Madison, Wisconsin

Allergies:

Date: Surgical procedure scheduled

OR nurse unit nurse check check 1. 1. Identification band checked 2. 2. Consent for surgery signed 3. 3. History & physical 4. 4. Note by surgeon 5. 5. NPO since

11.

__

Yes or No

~

6.

7.

~

______

Yes or No Yes or No

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Time 6. Condition when leaving for surgery (circle) Oriented, drowsy, asleep, nonresponsive, very restless, apprehensive, disoriented, very talkative 7. Type & crossmatch No units available _ _ Not ordered Being done 8. Anti-embolism stockings On . Not ordered 9. Family Absent 4C surgical waiting At this number .. .~ Other 10. Handicaps or special precautions (Circle) Immobile joint, paralysis, diabetic, infections, speech & hearing disorders (describe), blind, none ~~

~

~

9.

~

-

~

Time

Yes or No

~

8.

12.

11. Urinalysis CBC Results on chart Specimen to lab Not done 12. Voided Yes or No

~

13. Retention catheter

__

Yes or No 14.

14

None wlgs Hair pins Nail polish Make-up Jewelry 15 Dentures None Bridge Partial Plates Eyes Artificial Contacts __ Other prosthesis ~

Removed ~

~

~~

~

15.

-

__

Removed

~

~~

__

~

~

~

10.

~

Signature: OR RN

Signature: Unit RN

PERMANENT: MAINTAIN WITH RECORD

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If a patient asks a question about the operative procedure, which has probably been answered by the surgeon, the nurse may ask what information he already has. The nurse in the holding area needs to be perceptive and sensitive t o the patient’s needs. In a relatively brief interaction, the nurse assesses a patient, makes appropriate plans based on the data, implements that plan, and evaluates it if possible. What sources of assessment data are accessible to the nurse in the surgical reception area? Of course, the patient, in most instances, is a prime source. In addition, the patient’s chart and the nurse’s notes are also data bases. Another valuable and readily available source of information is the preoperative teaching guide, which documents preoperative teaching done by the patient’s nurse on the unit as well as the patient’s response to that teaching. The preoperative teaching guide is conveniently located on the back of the preoperative checklist. Both are permanent parts of the patient’s chart. The nurse in the reception area is the patient’s advocate and his link between the preoperative and intraoperative periods. He or she also provides continuity between the patient’s preoperative and immediate postoperative period. For example, the nurse might learn that the patient reacted negatively to anesthesia during an earlier surgery and emerged from the anesthetic fighting. The patient, however, did not mention this t o t h e anesthesiologist. By informing the anesthesiologist, surgeon, and recovery room staff, the nurse individualizes the patient’s care. Although a few surgeons visit patients in the holding area, most visit patients on the unit and then see them again in the operating room before the anesthetic is administered. The patient remains in the surgical reception area

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until the operating room and team are ready and the surgeon is scrubbing. Then, the registered nurse who will be circulating for that patient’s surgery introduces himself or herself to the patient and transports him to the appropriate operating room. The nurse i n the reception area provides quality nursing care by carrying out the previously described responsibilities. In addition, he or she contributes to total quality nursing care by conducting periodic audits of the preoperative teaching guides. The nurse provides an “internal check’ by verifying completeness of the information obtained and apprises the operating room nurses of the results. In turn, the operating room nurses share data with the nurses on the surgical units. The vital importance of the registered nurse in the surgical receplion x e a cannot be discounted. Consistent and conscientious application of the nursing process enables the nurse to see patients as unique individuals and to provide and facilitate individualized nursing care. 0

AORN Journal, June 1978, Val 27, No 7

Nursing care in the surgical reception area.

urgery is potentially anxiety producing for any patient. Professional registered nurses use a myriad of approaches to decrease this anxiety. Nurses on...
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