Photo by Alan Goldstein
Preoperative group sessions part of nursing process Barbara J Gruendemann, RN
Nursing process can be a guide to day-by-day patient care in the operating room. As a term, nursing process is not new, but in practical application, it is just beginning to be used effectively as a basis for nursing practice. Defined, nursing process is a systematic way of looking a t patient care versus a “scatterbrain” or ngUesswork’ approach. It means we use our brains and think logically about our patient and his responses to his surgery and the plan of care that follows. If we use the nursing process in our work in the operating room, we eliminate intuition, trial and error, and hit-and-miss judgments. How much better it is that each of our patients comes to the operating room with the expectation that his care is individualized and that he is assured of a safe and comfortable environment for his surgery. Nursing process is nothing more than humanizing the care we give to our patients. If your operating room resembles a Detroit assembly line, however, where bodies are brought in on one conveyance, worked on in some manner, and then sent out on another conveyance, you are not using the nursing process. You probably have skilled technical workers and high efficiency, measured by how fast the schedule is completed and how neatly everything is put away on the shelves after the procedures are finished. You probably refer to patients as cases. You may even refer to a patient as “it” when asking, “Did you send for i t yet?” as you point to the next hernia listed on the schedule. I believe we’re all guilty of this. How can you humanize care and still be efficient and keep the schedule progressing on time? It is possible if some part of your care and hustle and bustle focuses on the patient. In the film, “Update: OR nursing,”
AORN Joirrnul. August 1977, Vol 26. No 2
257
Centinela Preoperative instruction
Preoperative classes are held each evening after visiting hours. These classes were created to prepare you for your surgical experience and to aid you in a smoother remvery; therefore, we urge you to attend. You will be escorted to and from the class by a nursing attendant. Friends and relatives are welcome. Time: 8 to 9 pm Place: Centinela room Attire: A s you desirepajamas and robe acceptable. If you have any questions about the class, ask your nurse. This invitation is given to each surgical patient on admittance to Centinela Hospital.
which premiered a t the 1977 AORN Congress, the scientific concept of the nursing process is translated in the everyday work-world of the operating room. It shows excellence in patient care and follows the vocabulary of Standards o f Nursing Practice: Operating Room. The film visually interprets the standards and depicts how nursing care can be changed by using the standards, which focus on the nursing process. The nursing process has four basic components: assessment, planning, intervention, and evaluation. Assessment is knowing something about your patient as a person and as a candidate for a surgical procedure. You may do your assessments in a special holding area, through preoperative visits, or with nursing care plans begun on the units. Planning means accurately anticipating the procedure with the necessary equipment and supplies and preparing drugs, solutions, and special
258
drapes that will be needed. Planning also means that adequately trained people are scrubbing and circulating in each room. It is using surgeon’s preference cards and nursing guides to prepare the rooms. At Centinela Hospital, Inglewood, Calif, we are planning to experiment with nursing guides that are cards outlining steps of a certain procedure, positioning aids, and safety precautions for the patient. These will be done for procedures and will complement, not replace, surgeon’s preference cards. Planning means knowing the anatomy of a body area so you can follow the steps of a n operation and have sutures and instruments ready. It means taking the initiative to learn by reading a journal article or searching the literature about a certain procedure or condition before being assigned to it. Planning means you have extra help when you know your patient has immobility or difficulty in moving certain joints. It also means a n extra comforting touch of the hand when you know your patient is extremely frightened. Implementation of nursing care is doing what you planned and following well-thought-out routines and reasoning. Evaluation is checking the results of what you did to see if they helped or hindered the patient. Evaluation can be done through audit, peer review, small informal studies of practices in your operating room, or interviews with your patients postoperatively. Some nurses respond to the nursing process with: “We’re too busy to do all that,” “That’s for the teaching hospitals,” or “That way is too complicated, and, besides, ulii surgeons don’t want us talking to thcir patients.” Many OR nurses have goud intentions but experience resistance from other sources.
AORN Journal, August 1977,V o l 2 6 , N o 2
One example of the nursing process in use is in the operating room a t Centinela Hospital, a public, nonprofit 275-bed institution in the process of expanding to 350 beds. A general hospital, it has all major services and is planning an open heart surgery program. There are 8 operating rooms ( w e use 6 t o 7 each day) and will increase t o 12 with the new addition. General and all specialty surgeries are done, orthopedics being about one-third of the surgery load. The average monthly number of procedures is 610. The OR staff consists of 23 RNs, seven operating room technicians, and five nursing assistants for 7-dayl24-hour-a-day coverage. About a year and a half ago, a group of dedicated OR and medical-surgical nurses put together a group preopera-
Barbara J Gruendemann, R N , M S , A O R N vice-president, is an O R nurse clinician at Centinela Hospital, Znglewood, Calif. She received a B S N from the University of Wisconsin, Madison, and a n MS in nursing f r o m the University of California at Los Angeles. This paper is adapted from a presentation at the 1977 A O R N Congress with the premiere of the f i l m “Update: O R nursing.” The author acknowledges the help and support o f the preoperative instructors at Centinela Hospital.
tive teaching program for patients, complete with a manual and instructions for the teachers. The appropriate hospital and physician committees gave full approval and support for the program. Classes were taught in the evening and were highly successful according to the staff and patients. Because there were problems getting patients to the classes, the program ceased about a year ago. The need for the classes continued, however, and after several weeks of planning and correcting the previous problems, we restarted the program in November. We definitely use the nursing process in our care of patients. As surgical patients are admitted to Centinela, they receive a printed invitation to the class and are again invited and informed by the unit nurses. Patients and their families are strongly encouraged to attend but never forced. The classes are held after visiting hours Sunday through Thursday from 8 to 9 pm. Obtaining registered nurse teachers has been no problem. Seven are from the operating room and one is from a surgical nursing unit. We teach on a rotating schedule. An obstetrics nurse and the inservice coordinator are alternate teachers. Several other RNs have substituted and expressed interest in becoming regular teachers. The classes are informal, and we use slides taken by our hospital photographer, a n instructional pamphlet, general discussion, and question-and-answer periods. The slides show doors and hallways in the operating suite, a gurney, transporting personnel, the holding area, a n OR “bed,” a strap, intravenous infusion, a blood pressure cuff, a ground plate, monitor electrodes, a view of the OR team members, a view of the nurses and overhead lights from patient’s viewpoint,
AORN Journal. August 1977, V o l 2 6 , N o 2
259
the recovery room, a n oxygen mask in RR, splinting wound area for coughing and deep breathing, and the procedure for getting out of bed postoperatively. More slides are being added, among them catheters and drains. We do not discuss actual procedures or specific anesthetics, and questions related t o these are referred to the surgeon or anesthesiologist. The objectives for the class are 1. to inform preoperative patients of common and routine procedures and events related t o the surgery 2. to orient patients to the sensory experiences related to surgery (things they will see, hear, and feel) 3. to help patients understand the role of nurses working in the OR and on nursing units (team concept and the duties of each member) 4. to demonstrate coughing, deep breathing, leg and turning exercises that can lead to a smoother, faster recovery 5 . to present ourselves as professional, caring nurses interested in each patient's welfare and outcome 6. to give patients and families a chance to ask questions of concern related to their surgery 7. to allow for patient group support of each other as they face surgery together. The group support objective has proven to be extremely important, and we now feel that group classes may have advantages over individual preoperative visits. In a group setting, patients seem to sense they are not alone in their feelings about'their upcoming surgeries. Through shared feelings and mutual trust, they seem to adapt t o the situation more easily and are able t o express individual concerns related to the surgery or diagnosis, getting feedback from the other group members or the instructor. Al-
260
Class discussion items purposes of the class open class format role of OR, RR, and unit nurses coughing, deep breathing, moving, and leg exercises NPO laboratory studies and x-rays consent normalcy of some anxieties shave preps visit by anesthesiologist preoperative medications and sensory effects side rails surgical checklist family and visitors Ivs dentures, prostheses OR environment team members and their functions recovery room-vital signs, oxygen discomfort and pain dressings, casts, tubings, drains activity schedule getting out of bed with and without assistance of RN availability of chaplain and other resource persons
A checklist comprising these items is used by the nurse in conducting the preoperative class.
though w e have only subjective data, we believe sharing and listening to each other often remove some fear and anxiety. Patients have verbalized these advantages also. The instructors are pleased but surprised at these outcomes, especially
AORN Journal, August 1977, V o l 2 6 , N o 2
since group members changd nightly and, therefore, preclude the long-term development of one stable group. Perhaps impending surgery is a stressor powerful enough to evoke strong needs for mutual sharing. It may also be true that individuals awaiting a fearful event are motivated to affiliate with others. Further study is needed, however, to validate these beliefs. Patients easily sense that they are all “in the same boat” and seek each other out in the classes discussing their scheduled surgeries, showing each other their knees or elbows, and then visiting after they go back to the nursing units. In the operating room holding area, we often see patients greeting or reaching out to pat the shoulder of someone they met the night before in class. Although the classes follow a schedule, they are flexible, and time is always allowed for questions and listening to individual concerns. Patients do not seem reticent to ask questions in a group and often ask them of other patients as well. Each teacher stays after the class to answer any personal questions the patients may have but most seem comfortable asking them in a group. We are not without problems for there are times when only two patients come, and we have to call the units and remind and encourage them to bring the patients to the class. There are times when space is a t a premium, and we have to make room for a maternity tea or move to the main cafeteria where the 20-gallon coffee pot gurgles so loudly we can hardly hear. Sometimes, the projector breaks down, or the slides are in upside down. But these problems we can handle and solve; we are working on better communications with the nurs-
ing units so more patients come to class. Each patient in the class fills out a form, which is placed in his or her operating room the next morning so the circulator knows which patients attended the class. These forms, explained to the group by the instructor, include any information the patients would like their OR nurse to know. Examples are hearing or sight difficulties, allergies, joint or muscle problems, medical conditions such as diabetes or hypertension, and fears and anxieties. These forms help the circulator who uses them in planning her care and interactions with the patients. We are highly encouraged by the administrative and physician support we have a t Centinela. Patients tell their surgeons about their experiences in the classes, and we hear frequent comments from the surgeons. Surgeons do not seem to think we are usurping their territory; none object to the classes, and, in fact, some even write a n order or insist their patients go to the classes. The recovery room staff has also expressed beneficial results-patients cough, deep breathe, and move easier. They also do not fight the oxygen mask because they know it is a common routine that will eliminate the anesthetic faster. In follow-up interviews, almost all patients have said the classes are extremely beneficial. The most frequent comment is, “I wasn’t as afraid because I knew what was going to happen.” Others have said: “Made me much less apprehensive.” “Slides were especially helpful .” “Class was good, but surgery still scares me.” “Made me feel relaxed.” “Whole experience very positive.” “Teacher encouraged me.” “Marvelous idea.” “Good to know someone is with you at all times, both
AORN Journal, August 1977, V o l 2 6 , N o 2
261
in surgery and recovery room.” “Whole thing was worthwhile and helped my family, too.” Although it is difficult to measure quality and satisfaction, we know our group classes are effective and we intend to do more follow-up studies. We believe we have humanized OR nursing care. Nurses also are deriving satisfaction from this interaction with the patients. If you are asking yourself, Can we implement the nursing process in our operating room? Can we make our nursing care come alive?, the answer is yes, if you set reasonable practical goals, work on one small step a t a time, and always keep in mind that the nursing process does work. It can be implemented in many ways in the operating room and with surgical patients. “Utilization of the nursing process opens the door for the operating room nurse. No longer need she stay behind her mask and be a shadow figure in patient care, but by assessing, planning, implementing, and evaluating her care, she can become a vital participant in patient care.”: 0 Notes 1. Updete: OR Nursing, film produced by Association of Operating Room Nurses, Denver. Distributed by Davis + Geck Surgical Film Library, Danbury, Conn, 1977. References “A better way to calm the patient who fears the worst.” RN 40 (April 1977) 47-54. Marriner, Ann. The Nursing Process, A Scientific Approach to Nursing Care. St Louis: C V Mosby Co, 1975. Morris, William N, et al. “Collective coping with stress: Group reactions to fear, anxiety, and ambiguity.” Journal of Personality and Social Psychology 33 (1976) 674-679. Nicholls, Marion E, Wessells, Virginia G, eds. Nursing Stendards end Nursing Process. Wakefield, Mass: Contemporary Publishing Co,
Sweeney, Bernadette. “Learning groups: Survival level, growth level.” Journal of Nursing Educetion 14 (August 1975) 2G26.
AANA new director, annual meeting J Martin Stone has been appointed executive director of the American Association of Nurse Anesthetists (AANA) by the AANA Board of Directors. He will supervise all activities of the 17,000-member organization. Regional director of Hospital Affiliates International, Inc, for two years, Stone received his bachelor’s degree from Dartmouth College, Hanover, NH. He holds a master’s degree in hospital administration from the University of Michigan, Ann Arbor. Stone has also served as associate director of the Joint Commission on Accreditation of Hospitals and as an assistant to the senior vice-president of the American Hospital Association. A guest lecturer at the George Washington University Department of Health Care Administration, Washington, DC, at the University of Minnesota, Minneapolis, and at University of Chicago Center for Health Administration Studies, Stone has also been a faculty member of Chicago City College. AANA will hold its 44th annual meeting Aug 21 to Aug 25 in Hollywood, Fla. The theme will be “Preparing for tomorrow, today.” Leading nurses, physicians, lawyers, and other professional experts will present numerous sessions on conduction anesthesia, EKG cardiology, anesthesia department management, and external agencies that impact on the profession. For registration information, contact the American Association of Nurse Anesthetists, 111 E Wacker Dr, Chicago, Ill 60601.
1977. Strickland, Ben. ”Group dynamics-a point of view.” Journal of the American Dietetic Association 69 (October 1976) 373-376.
262
AORN Journal, August 1977,V o l 2 6 , No 2
Preoperative group sessions part of nursing process Barbara J Gruendemann, RN
Nursing process can be a guide to day-by-day patient care in the operating room. As a term, nursing process is not new, but in practical application, it is just beginning to be used effectively as a basis for nursing practice. Defined, nursing process is a systematic way of looking a t patient care versus a “scatterbrain” or ngUesswork’ approach. It means we use our brains and think logically about our patient and his responses to his surgery and the plan of care that follows. If we use the nursing process in our work in the operating room, we eliminate intuition, trial and error, and hit-and-miss judgments. How much better it is that each of our patients comes to the operating room with the expectation that his care is individualized and that he is assured of a safe and comfortable environment for his surgery. Nursing process is nothing more than humanizing the care we give to our patients. If your operating room resembles a Detroit assembly line, however, where bodies are brought in on one conveyance, worked on in some manner, and then sent out on another conveyance, you are not using the nursing process. You probably have skilled technical workers and high efficiency, measured by how fast the schedule is completed and how neatly everything is put away on the shelves after the procedures are finished. You probably refer to patients as cases. You may even refer to a patient as “it” when asking, “Did you send for i t yet?” as you point to the next hernia listed on the schedule. I believe we’re all guilty of this. How can you humanize care and still be efficient and keep the schedule progressing on time? It is possible if some part of your care and hustle and bustle focuses on the patient. In the film, “Update: OR nursing,”
AORN Joirrnul. August 1977, Vol 26. No 2
257
Centinela Preoperative instruction
Preoperative classes are held each evening after visiting hours. These classes were created to prepare you for your surgical experience and to aid you in a smoother remvery; therefore, we urge you to attend. You will be escorted to and from the class by a nursing attendant. Friends and relatives are welcome. Time: 8 to 9 pm Place: Centinela room Attire: A s you desirepajamas and robe acceptable. If you have any questions about the class, ask your nurse. This invitation is given to each surgical patient on admittance to Centinela Hospital.
which premiered a t the 1977 AORN Congress, the scientific concept of the nursing process is translated in the everyday work-world of the operating room. It shows excellence in patient care and follows the vocabulary of Standards o f Nursing Practice: Operating Room. The film visually interprets the standards and depicts how nursing care can be changed by using the standards, which focus on the nursing process. The nursing process has four basic components: assessment, planning, intervention, and evaluation. Assessment is knowing something about your patient as a person and as a candidate for a surgical procedure. You may do your assessments in a special holding area, through preoperative visits, or with nursing care plans begun on the units. Planning means accurately anticipating the procedure with the necessary equipment and supplies and preparing drugs, solutions, and special
258
drapes that will be needed. Planning also means that adequately trained people are scrubbing and circulating in each room. It is using surgeon’s preference cards and nursing guides to prepare the rooms. At Centinela Hospital, Inglewood, Calif, we are planning to experiment with nursing guides that are cards outlining steps of a certain procedure, positioning aids, and safety precautions for the patient. These will be done for procedures and will complement, not replace, surgeon’s preference cards. Planning means knowing the anatomy of a body area so you can follow the steps of a n operation and have sutures and instruments ready. It means taking the initiative to learn by reading a journal article or searching the literature about a certain procedure or condition before being assigned to it. Planning means you have extra help when you know your patient has immobility or difficulty in moving certain joints. It also means a n extra comforting touch of the hand when you know your patient is extremely frightened. Implementation of nursing care is doing what you planned and following well-thought-out routines and reasoning. Evaluation is checking the results of what you did to see if they helped or hindered the patient. Evaluation can be done through audit, peer review, small informal studies of practices in your operating room, or interviews with your patients postoperatively. Some nurses respond to the nursing process with: “We’re too busy to do all that,” “That’s for the teaching hospitals,” or “That way is too complicated, and, besides, ulii surgeons don’t want us talking to thcir patients.” Many OR nurses have goud intentions but experience resistance from other sources.
AORN Journal, August 1977,V o l 2 6 , N o 2
One example of the nursing process in use is in the operating room a t Centinela Hospital, a public, nonprofit 275-bed institution in the process of expanding to 350 beds. A general hospital, it has all major services and is planning an open heart surgery program. There are 8 operating rooms ( w e use 6 t o 7 each day) and will increase t o 12 with the new addition. General and all specialty surgeries are done, orthopedics being about one-third of the surgery load. The average monthly number of procedures is 610. The OR staff consists of 23 RNs, seven operating room technicians, and five nursing assistants for 7-dayl24-hour-a-day coverage. About a year and a half ago, a group of dedicated OR and medical-surgical nurses put together a group preopera-
Barbara J Gruendemann, R N , M S , A O R N vice-president, is an O R nurse clinician at Centinela Hospital, Znglewood, Calif. She received a B S N from the University of Wisconsin, Madison, and a n MS in nursing f r o m the University of California at Los Angeles. This paper is adapted from a presentation at the 1977 A O R N Congress with the premiere of the f i l m “Update: O R nursing.” The author acknowledges the help and support o f the preoperative instructors at Centinela Hospital.
tive teaching program for patients, complete with a manual and instructions for the teachers. The appropriate hospital and physician committees gave full approval and support for the program. Classes were taught in the evening and were highly successful according to the staff and patients. Because there were problems getting patients to the classes, the program ceased about a year ago. The need for the classes continued, however, and after several weeks of planning and correcting the previous problems, we restarted the program in November. We definitely use the nursing process in our care of patients. As surgical patients are admitted to Centinela, they receive a printed invitation to the class and are again invited and informed by the unit nurses. Patients and their families are strongly encouraged to attend but never forced. The classes are held after visiting hours Sunday through Thursday from 8 to 9 pm. Obtaining registered nurse teachers has been no problem. Seven are from the operating room and one is from a surgical nursing unit. We teach on a rotating schedule. An obstetrics nurse and the inservice coordinator are alternate teachers. Several other RNs have substituted and expressed interest in becoming regular teachers. The classes are informal, and we use slides taken by our hospital photographer, a n instructional pamphlet, general discussion, and question-and-answer periods. The slides show doors and hallways in the operating suite, a gurney, transporting personnel, the holding area, a n OR “bed,” a strap, intravenous infusion, a blood pressure cuff, a ground plate, monitor electrodes, a view of the OR team members, a view of the nurses and overhead lights from patient’s viewpoint,
AORN Journal. August 1977, V o l 2 6 , N o 2
259
the recovery room, a n oxygen mask in RR, splinting wound area for coughing and deep breathing, and the procedure for getting out of bed postoperatively. More slides are being added, among them catheters and drains. We do not discuss actual procedures or specific anesthetics, and questions related t o these are referred to the surgeon or anesthesiologist. The objectives for the class are 1. to inform preoperative patients of common and routine procedures and events related t o the surgery 2. to orient patients to the sensory experiences related to surgery (things they will see, hear, and feel) 3. to help patients understand the role of nurses working in the OR and on nursing units (team concept and the duties of each member) 4. to demonstrate coughing, deep breathing, leg and turning exercises that can lead to a smoother, faster recovery 5 . to present ourselves as professional, caring nurses interested in each patient's welfare and outcome 6. to give patients and families a chance to ask questions of concern related to their surgery 7. to allow for patient group support of each other as they face surgery together. The group support objective has proven to be extremely important, and we now feel that group classes may have advantages over individual preoperative visits. In a group setting, patients seem to sense they are not alone in their feelings about'their upcoming surgeries. Through shared feelings and mutual trust, they seem to adapt t o the situation more easily and are able t o express individual concerns related to the surgery or diagnosis, getting feedback from the other group members or the instructor. Al-
260
Class discussion items purposes of the class open class format role of OR, RR, and unit nurses coughing, deep breathing, moving, and leg exercises NPO laboratory studies and x-rays consent normalcy of some anxieties shave preps visit by anesthesiologist preoperative medications and sensory effects side rails surgical checklist family and visitors Ivs dentures, prostheses OR environment team members and their functions recovery room-vital signs, oxygen discomfort and pain dressings, casts, tubings, drains activity schedule getting out of bed with and without assistance of RN availability of chaplain and other resource persons
A checklist comprising these items is used by the nurse in conducting the preoperative class.
though w e have only subjective data, we believe sharing and listening to each other often remove some fear and anxiety. Patients have verbalized these advantages also. The instructors are pleased but surprised at these outcomes, especially
AORN Journal, August 1977, V o l 2 6 , N o 2
since group members changd nightly and, therefore, preclude the long-term development of one stable group. Perhaps impending surgery is a stressor powerful enough to evoke strong needs for mutual sharing. It may also be true that individuals awaiting a fearful event are motivated to affiliate with others. Further study is needed, however, to validate these beliefs. Patients easily sense that they are all “in the same boat” and seek each other out in the classes discussing their scheduled surgeries, showing each other their knees or elbows, and then visiting after they go back to the nursing units. In the operating room holding area, we often see patients greeting or reaching out to pat the shoulder of someone they met the night before in class. Although the classes follow a schedule, they are flexible, and time is always allowed for questions and listening to individual concerns. Patients do not seem reticent to ask questions in a group and often ask them of other patients as well. Each teacher stays after the class to answer any personal questions the patients may have but most seem comfortable asking them in a group. We are not without problems for there are times when only two patients come, and we have to call the units and remind and encourage them to bring the patients to the class. There are times when space is a t a premium, and we have to make room for a maternity tea or move to the main cafeteria where the 20-gallon coffee pot gurgles so loudly we can hardly hear. Sometimes, the projector breaks down, or the slides are in upside down. But these problems we can handle and solve; we are working on better communications with the nurs-
ing units so more patients come to class. Each patient in the class fills out a form, which is placed in his or her operating room the next morning so the circulator knows which patients attended the class. These forms, explained to the group by the instructor, include any information the patients would like their OR nurse to know. Examples are hearing or sight difficulties, allergies, joint or muscle problems, medical conditions such as diabetes or hypertension, and fears and anxieties. These forms help the circulator who uses them in planning her care and interactions with the patients. We are highly encouraged by the administrative and physician support we have a t Centinela. Patients tell their surgeons about their experiences in the classes, and we hear frequent comments from the surgeons. Surgeons do not seem to think we are usurping their territory; none object to the classes, and, in fact, some even write a n order or insist their patients go to the classes. The recovery room staff has also expressed beneficial results-patients cough, deep breathe, and move easier. They also do not fight the oxygen mask because they know it is a common routine that will eliminate the anesthetic faster. In follow-up interviews, almost all patients have said the classes are extremely beneficial. The most frequent comment is, “I wasn’t as afraid because I knew what was going to happen.” Others have said: “Made me much less apprehensive.” “Slides were especially helpful .” “Class was good, but surgery still scares me.” “Made me feel relaxed.” “Whole experience very positive.” “Teacher encouraged me.” “Marvelous idea.” “Good to know someone is with you at all times, both
AORN Journal, August 1977, V o l 2 6 , N o 2
261
in surgery and recovery room.” “Whole thing was worthwhile and helped my family, too.” Although it is difficult to measure quality and satisfaction, we know our group classes are effective and we intend to do more follow-up studies. We believe we have humanized OR nursing care. Nurses also are deriving satisfaction from this interaction with the patients. If you are asking yourself, Can we implement the nursing process in our operating room? Can we make our nursing care come alive?, the answer is yes, if you set reasonable practical goals, work on one small step a t a time, and always keep in mind that the nursing process does work. It can be implemented in many ways in the operating room and with surgical patients. “Utilization of the nursing process opens the door for the operating room nurse. No longer need she stay behind her mask and be a shadow figure in patient care, but by assessing, planning, implementing, and evaluating her care, she can become a vital participant in patient care.”: 0 Notes 1. Updete: OR Nursing, film produced by Association of Operating Room Nurses, Denver. Distributed by Davis + Geck Surgical Film Library, Danbury, Conn, 1977. References “A better way to calm the patient who fears the worst.” RN 40 (April 1977) 47-54. Marriner, Ann. The Nursing Process, A Scientific Approach to Nursing Care. St Louis: C V Mosby Co, 1975. Morris, William N, et al. “Collective coping with stress: Group reactions to fear, anxiety, and ambiguity.” Journal of Personality and Social Psychology 33 (1976) 674-679. Nicholls, Marion E, Wessells, Virginia G, eds. Nursing Stendards end Nursing Process. Wakefield, Mass: Contemporary Publishing Co,
Sweeney, Bernadette. “Learning groups: Survival level, growth level.” Journal of Nursing Educetion 14 (August 1975) 2G26.
AANA new director, annual meeting J Martin Stone has been appointed executive director of the American Association of Nurse Anesthetists (AANA) by the AANA Board of Directors. He will supervise all activities of the 17,000-member organization. Regional director of Hospital Affiliates International, Inc, for two years, Stone received his bachelor’s degree from Dartmouth College, Hanover, NH. He holds a master’s degree in hospital administration from the University of Michigan, Ann Arbor. Stone has also served as associate director of the Joint Commission on Accreditation of Hospitals and as an assistant to the senior vice-president of the American Hospital Association. A guest lecturer at the George Washington University Department of Health Care Administration, Washington, DC, at the University of Minnesota, Minneapolis, and at University of Chicago Center for Health Administration Studies, Stone has also been a faculty member of Chicago City College. AANA will hold its 44th annual meeting Aug 21 to Aug 25 in Hollywood, Fla. The theme will be “Preparing for tomorrow, today.” Leading nurses, physicians, lawyers, and other professional experts will present numerous sessions on conduction anesthesia, EKG cardiology, anesthesia department management, and external agencies that impact on the profession. For registration information, contact the American Association of Nurse Anesthetists, 111 E Wacker Dr, Chicago, Ill 60601.
1977. Strickland, Ben. ”Group dynamics-a point of view.” Journal of the American Dietetic Association 69 (October 1976) 373-376.
262
AORN Journal, August 1977,V o l 2 6 , No 2
