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OR Fact and Principle
OR FACT AND PRINCIPLE Frances Reeser, R.N. Q. Could you recommend a simple method for instituting a system of pie-operative nurse visits to surgical patients, especially when the hospital does not agree with this theory? A. The ward nurse, due to her close proximity to the patient, has always been the individual who was expected to answer the patient’s questions. However, pre-operative visits from the operating room nurse have proved valuable to the patient, and operating room personnel are being encouraged to make them. If management does not see the value of these visits, the operating room supervisor should endeavor to get permission for a trial period. She should impress on management the logic behind the visits: they give the nurse the opportunity to see the patient as an individual, not as a case. Since the operating room nurse has the ability to make nursing diagnoses, and since she can implement the necessary definitive action, she often provides valuable information and is able to evaluate needs. This results in less fear and anxiety on the part of the patient. A post-operative visit from the Recovery Room or Intensive Care nurse to give instructions, such as the need for deep breathing, passive and active exercises, etc., is also valuable.
June 1969
a:
When management sees the results gained by such visits, they will be willing to accept them as a much needed routine procedure.
Q. Within a particular hospital structure, to whom should the Operating Room training program instructor be responsible? A. The hospital organizational chart usually shows the instructor as being directly responsible to the in-service Education Director and working closely with the Operating Room Supervisor in correlating the program. The Supervisor supports the instructor’s program, assists in planning course content, and makes proper facilities available, such as an idle operating room for demonstrations. She also correlates the cases required for the learning experience. She may assist the instructor in obtaining teaching material. A qualified instructor should have no other responsibilities or service commitments except to teach. Q. How much control should the instructor have over her students’ experience, both in and outside the classroom? Should this control be exercised only early in the program, or should it exist for the duration of the operating room experience? A. The instructor should have control Continued on page 105
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over and responsibility for her students for the length of time the program is in progress. For example, if the operating room experience for students is four weeks, the guidance of the instructor should be for four weeks. The instructor should be available to assist the student in the correlation of classroom theory and operating room practice. She might serve as both teacher and counselor during the student’s operating room experience.
Q. Is it acceptable practice to sterilize wire sutures on the wooden spool?
A. This practice is hazardous to tissue. Heat draws resins from the wood which are then deposited on the wire sutures. These deposits act as foreign body irritants to tissue.
Q. How do you sterilize a large piece of rubber sheeting to be used between the patient and the sterile drape in areas where there is
profuse wetness, such as in neurosurgery? A. The rubber sheet is extremely difficult to sterilize because of its size and texture. It should be rolled rather than folded because steam has difficulty penetrating the folded areas of the large rubber material. It can be rolled in a cotton sheet to prevent creases and folds, and to keep its surfaces from touching and possibly sticking together.
Q. We have been told that there is a prosthesis available to help restore function to hands disabled by rheumatoid arthritis. Is there such an item available? A. Yes, there is a prosthesis designed for metacapophalangeal and proximal interphalangeal joint implant arthroplasty. It is a medical-grade silicone elastomer implant which, as an internal splint, preserves normal joint relationship during formation of the supportive fibrous joint capsule. A silastic Continued on page 107
IINEW IDEll lor saler and easler 1 Instrument selectlon and uresen depress the desired instrument tilt the instrument toa 4 5 O position for ease and safety in removing it from the rack. This action eliminates the precarious difficulty of grasp ing a small instrument lying closely between others in a rack.
June 1969
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finger joint prosthesis is available in sizes adequate to various operative requirements.
Q. A controversy has arisen within our department concerning the correct technique, or theory, in performing an abdominal skin prep. The question concerns how to treat the umbilicus. After the initial cleaning of the umbilicus, is it permissible to pass over it and then on to surrounding tissue or the incisional area with the same prep sponge? Is it to be treated as a dirty area, or is it considered to be as clean as the remainder of the abdomen after the initial cleansing? A. Be sure that the patient has been properly shaved. Report any unusual skin conditions to the surgeon. The abdominal area can then be scrubbed with a hexachlorophene solution. The time allotted for this scrub should be set by your
June 1969
operating room policy. We feel that ten minutes is desirable. Begin scrubbing the area using a circular motion from the proposed site of incision and rotating outward to the end of the area designated for prep. As sponges become soiled, discard and use fresh ones. Because of crevices and the depth of the umbilicus, it is considered to be more contaminated than the other surfaces of the abdomen. This area should be cleansed well using applicators. The umbilicus is then filled with the antiseptic solution of choice and left until the remainder of the prep has been completed. Begin from the center, avoid the umbilicus, work out, and never go back over the area. Then, cover the abdomen with the antiseptic solution. Several applications are desirable. When the prep is completed, the excess solution is removed from the umbilicus and the patient is properly draped.
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June 1969
a:
When management sees the results gained by such visits, they will be willing to accept them as a much needed routine procedure.
Q. Within a particular hospital structure, to whom should the Operating Room training program instructor be responsible? A. The hospital organizational chart usually shows the instructor as being directly responsible to the in-service Education Director and working closely with the Operating Room Supervisor in correlating the program. The Supervisor supports the instructor’s program, assists in planning course content, and makes proper facilities available, such as an idle operating room for demonstrations. She also correlates the cases required for the learning experience. She may assist the instructor in obtaining teaching material. A qualified instructor should have no other responsibilities or service commitments except to teach. Q. How much control should the instructor have over her students’ experience, both in and outside the classroom? Should this control be exercised only early in the program, or should it exist for the duration of the operating room experience? A. The instructor should have control Continued on page 105
103
Continued from page 103
over and responsibility for her students for the length of time the program is in progress. For example, if the operating room experience for students is four weeks, the guidance of the instructor should be for four weeks. The instructor should be available to assist the student in the correlation of classroom theory and operating room practice. She might serve as both teacher and counselor during the student’s operating room experience.
Q. Is it acceptable practice to sterilize wire sutures on the wooden spool?
A. This practice is hazardous to tissue. Heat draws resins from the wood which are then deposited on the wire sutures. These deposits act as foreign body irritants to tissue.
Q. How do you sterilize a large piece of rubber sheeting to be used between the patient and the sterile drape in areas where there is
profuse wetness, such as in neurosurgery? A. The rubber sheet is extremely difficult to sterilize because of its size and texture. It should be rolled rather than folded because steam has difficulty penetrating the folded areas of the large rubber material. It can be rolled in a cotton sheet to prevent creases and folds, and to keep its surfaces from touching and possibly sticking together.
Q. We have been told that there is a prosthesis available to help restore function to hands disabled by rheumatoid arthritis. Is there such an item available? A. Yes, there is a prosthesis designed for metacapophalangeal and proximal interphalangeal joint implant arthroplasty. It is a medical-grade silicone elastomer implant which, as an internal splint, preserves normal joint relationship during formation of the supportive fibrous joint capsule. A silastic Continued on page 107
IINEW IDEll lor saler and easler 1 Instrument selectlon and uresen depress the desired instrument tilt the instrument toa 4 5 O position for ease and safety in removing it from the rack. This action eliminates the precarious difficulty of grasp ing a small instrument lying closely between others in a rack.
June 1969
105
Continued from page 105
finger joint prosthesis is available in sizes adequate to various operative requirements.
Q. A controversy has arisen within our department concerning the correct technique, or theory, in performing an abdominal skin prep. The question concerns how to treat the umbilicus. After the initial cleaning of the umbilicus, is it permissible to pass over it and then on to surrounding tissue or the incisional area with the same prep sponge? Is it to be treated as a dirty area, or is it considered to be as clean as the remainder of the abdomen after the initial cleansing? A. Be sure that the patient has been properly shaved. Report any unusual skin conditions to the surgeon. The abdominal area can then be scrubbed with a hexachlorophene solution. The time allotted for this scrub should be set by your
June 1969
operating room policy. We feel that ten minutes is desirable. Begin scrubbing the area using a circular motion from the proposed site of incision and rotating outward to the end of the area designated for prep. As sponges become soiled, discard and use fresh ones. Because of crevices and the depth of the umbilicus, it is considered to be more contaminated than the other surfaces of the abdomen. This area should be cleansed well using applicators. The umbilicus is then filled with the antiseptic solution of choice and left until the remainder of the prep has been completed. Begin from the center, avoid the umbilicus, work out, and never go back over the area. Then, cover the abdomen with the antiseptic solution. Several applications are desirable. When the prep is completed, the excess solution is removed from the umbilicus and the patient is properly draped.
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107