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First assisting can be part of nursing role
Disinfection of arthroscope criticized In “Arthroscopy to diagnose knee disorders”, (April 1978), it is stated that the arthroscope is soaked in activated glutaraldehyde for 20 minutes between cases. The latest information I have on activated glutaraldehyde is that sterilization takes approximately ten hours and disinfection takes place in ten minutes. An instrument is sterile or unsterile, and one soaked for 10, 20, or 60 minutes in activated glutaraldehyde is unsterile. The practice of introducing an unsterile object into a joint is just not acceptable in our present state of awareness and responsibility. Proper care of sophisticated and expensive instruments in commendable, but how about proper care of the patient? An orthopedic surgeon using an unsterile instrument like that and a surgical nurse giving him one-for shame. Betty Rogers, RN Salinas, Calif Editor’s note: For further discussion of the question of sterilization vs disinfection of arthroscopes, see AORN Journal (December 1977), “The experts research: Q & A,” pp 1125-1 126, and AORN Journal (January 1978), “Surgeons discuss problems in asepsis,” pp 86-87.
First assisting can be part of nursing role The question whether the OR nurse should function as first assistant to the surgeon in the operating room demands comments. Nurses who say, “This is not nursing,” will surely jeopardize themselves as they did in the past when the physicians were looking for help. Think back over the past few years and the question of physician’s assistant. We decided that we were nurses, not anyone’s assistant,
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least of all a physician’s assistant. We balked at terminology; closed our eyes to the real future, needs, and trends; and plowed on in our own self-righteous way, resisting and denying. Had we stepped in early when the need arose, we could have set our own ground rules. Now we have nurse practitioners who have a great potential to nurses, to adhere to the nursing process, to concern themselves with the patient’s physical and mental well-being. We also have the physician’s assistant, who is less qualified but who, when asked to do the job, acts as a team member. This less-qualified person usually receives more pay although less qualified. Ask your personnel office staff, and they will probably tell you that 1. physician’s assistants and nurse practitioners are interchangeable, or 2. actually, physician’s assistants are better qualified and trained for the role“College background, you know, whereas nurses just have nursing.” We must not let this happen again in the operating room. I beg you to poke your nose outside the OR doors and look at those hospitals and facilities using physician’s assistants and nurse practitioners. Those working closely with the practitioners and physician’s assistants will tell you that nine times out of ten the nurse practitioner is by far the more valuable person. With advances in medicine and technology, we must move forward and experience role changes. Nursing has gone through many phases, from soothingthe fevered brow and carrying out the physician’s orders without question to using our acquired nursing knowledge to make judgments regarding functions of human anatomy and physiology and making definite decisions and plans for patient care. Is it then so inconceivable that in the near future someone will have to assist the surgeon in the OR as part of a team? Why cannot this be a part of nursing care? Are we going to step aside once again, we who are qualified, and let the less qualified physician’s assistant or technician assume these roles for us?
AORN Journal, July 1978, Vol28, N o 1
Nurses say that they don't want to work under the direction of a physician. What is wrong with being a team member when you have your own contributions to make. I say that nurses can still be nurses even though they are working alongside the surgeon as part of a team without losing their identity as nurses. Although any good ship has only one captain, there may be many qualified hands on board with their own expertise to offer. Nurses need to become involved, get themselves to lectures, and further their education and their nursing practice. Shirley A Roy, RN Director of nursing services Eunice Kennedy Shriver Center for Mental Retardation Waltham, Mass
Visits by RR nurses defended As a PAR nurse who has been making preoperative and postoperative visits to most of our surgical patients for the past year and a half, I would like to comment on the article "Problems with patient visits by RR nurses" by Sandra Wyatt and Mary Ellen Cullop, which appeared in the May 1978 Journal. I believe that it is obvious that one visit may not mean that a close or warm feeling has developed with the patient; the PAR (or OR) nurse is simply making himself or herself available to teach, reassure, empathize with, and perhaps even warn the patient. The nurse isn't the patient's "friend" much of the time, but he or she is someone who is showing an interest in facilitating an uneventful, comfortable, and mutually satisfactory postanesthetic recovery within the parameters of the anesthetic method and type of surgery. The nurse will not expose the patient's frustration or unhappiness or insecurity with one visit unless the patient desperately needs to talk about these things and unless the nurse is receptive enough to listen. The nurse will shield himself or herself, as the authors have pointed out, but to teach the patient how to "shield one's self from the deep realities of existence" is not within the scope of the preoperative visit. The individual situation will mandate whether such intervention is neces-
sary if the impending operation and recovery are to be conducive to the patient's well-being. By visiting the patient, we do place our own egos in jeopardy. If a nurse cannot deal with the anxiety, tension, sorrow, and feelings of helplessness or rejection that he or she will certainly experience from an occasional patient preoperatively or postoperatively, then it is best not to try to do these visits. When a preoperative visit does end with an embarrassed, anxious patient, it does not necessarily follow that the nurse must be frustrated. What are the dynamics behind the embarrassment? It is unlikely that the patient's anxiety is related to the particular nurse doing the visit, since they rarely see each other prior to the visit. Isn't it sufficient that the patient be nervous or scared-even scared to death at the thought of surgery-without scaring away that important link to our other world, the nurse who will guide the patient through recovery? The mystique surrounding surgery is sufficiently pervasive to frighten any patient. I have discovered so many unusual or unexpected reasons for preoperative fear that I now have no preconceptions as to how a certain patient will respond to my personality, apparel, instructions, or information. The patient who appears confident may be afraid of never waking up; the 10-year-old who spent the night alone and seemed so brave may scream for an hour in fear and indignation after his tonsillectomy, even after a visit. Fortunately, the PAR nurse is made like a nice soft sponge. I absorb incredible amounts of expressions of pain and fear from 6:45 am until 3:15 pm, when I wring myself out and go home. Incidentally, I have found that the preoperative visit is easier for the patient on the morning of surgery. I do not like the evenings-let the anesthesiologist visit then. I prefer the early morning, after the patient has slept (or not). The visit seems to work best the closer to the time of the operation, as the fears the patient may have will be closer to the surface. Increased anxiety also facilitates teaching and problem solving. The family is also more likely to be with the patient at that time and is given an opportunity to ask questions.
AORN Journal, July 1978, Vol28, No 1
Denise M Freeman, RN Santa Paula, Calif
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First assisting can be part of nursing role The question whether the OR nurse should function as first assistant to the surgeon in the operating room demands comments. Nurses who say, “This is not nursing,” will surely jeopardize themselves as they did in the past when the physicians were looking for help. Think back over the past few years and the question of physician’s assistant. We decided that we were nurses, not anyone’s assistant,
28
least of all a physician’s assistant. We balked at terminology; closed our eyes to the real future, needs, and trends; and plowed on in our own self-righteous way, resisting and denying. Had we stepped in early when the need arose, we could have set our own ground rules. Now we have nurse practitioners who have a great potential to nurses, to adhere to the nursing process, to concern themselves with the patient’s physical and mental well-being. We also have the physician’s assistant, who is less qualified but who, when asked to do the job, acts as a team member. This less-qualified person usually receives more pay although less qualified. Ask your personnel office staff, and they will probably tell you that 1. physician’s assistants and nurse practitioners are interchangeable, or 2. actually, physician’s assistants are better qualified and trained for the role“College background, you know, whereas nurses just have nursing.” We must not let this happen again in the operating room. I beg you to poke your nose outside the OR doors and look at those hospitals and facilities using physician’s assistants and nurse practitioners. Those working closely with the practitioners and physician’s assistants will tell you that nine times out of ten the nurse practitioner is by far the more valuable person. With advances in medicine and technology, we must move forward and experience role changes. Nursing has gone through many phases, from soothingthe fevered brow and carrying out the physician’s orders without question to using our acquired nursing knowledge to make judgments regarding functions of human anatomy and physiology and making definite decisions and plans for patient care. Is it then so inconceivable that in the near future someone will have to assist the surgeon in the OR as part of a team? Why cannot this be a part of nursing care? Are we going to step aside once again, we who are qualified, and let the less qualified physician’s assistant or technician assume these roles for us?
AORN Journal, July 1978, Vol28, N o 1
Nurses say that they don't want to work under the direction of a physician. What is wrong with being a team member when you have your own contributions to make. I say that nurses can still be nurses even though they are working alongside the surgeon as part of a team without losing their identity as nurses. Although any good ship has only one captain, there may be many qualified hands on board with their own expertise to offer. Nurses need to become involved, get themselves to lectures, and further their education and their nursing practice. Shirley A Roy, RN Director of nursing services Eunice Kennedy Shriver Center for Mental Retardation Waltham, Mass
Visits by RR nurses defended As a PAR nurse who has been making preoperative and postoperative visits to most of our surgical patients for the past year and a half, I would like to comment on the article "Problems with patient visits by RR nurses" by Sandra Wyatt and Mary Ellen Cullop, which appeared in the May 1978 Journal. I believe that it is obvious that one visit may not mean that a close or warm feeling has developed with the patient; the PAR (or OR) nurse is simply making himself or herself available to teach, reassure, empathize with, and perhaps even warn the patient. The nurse isn't the patient's "friend" much of the time, but he or she is someone who is showing an interest in facilitating an uneventful, comfortable, and mutually satisfactory postanesthetic recovery within the parameters of the anesthetic method and type of surgery. The nurse will not expose the patient's frustration or unhappiness or insecurity with one visit unless the patient desperately needs to talk about these things and unless the nurse is receptive enough to listen. The nurse will shield himself or herself, as the authors have pointed out, but to teach the patient how to "shield one's self from the deep realities of existence" is not within the scope of the preoperative visit. The individual situation will mandate whether such intervention is neces-
sary if the impending operation and recovery are to be conducive to the patient's well-being. By visiting the patient, we do place our own egos in jeopardy. If a nurse cannot deal with the anxiety, tension, sorrow, and feelings of helplessness or rejection that he or she will certainly experience from an occasional patient preoperatively or postoperatively, then it is best not to try to do these visits. When a preoperative visit does end with an embarrassed, anxious patient, it does not necessarily follow that the nurse must be frustrated. What are the dynamics behind the embarrassment? It is unlikely that the patient's anxiety is related to the particular nurse doing the visit, since they rarely see each other prior to the visit. Isn't it sufficient that the patient be nervous or scared-even scared to death at the thought of surgery-without scaring away that important link to our other world, the nurse who will guide the patient through recovery? The mystique surrounding surgery is sufficiently pervasive to frighten any patient. I have discovered so many unusual or unexpected reasons for preoperative fear that I now have no preconceptions as to how a certain patient will respond to my personality, apparel, instructions, or information. The patient who appears confident may be afraid of never waking up; the 10-year-old who spent the night alone and seemed so brave may scream for an hour in fear and indignation after his tonsillectomy, even after a visit. Fortunately, the PAR nurse is made like a nice soft sponge. I absorb incredible amounts of expressions of pain and fear from 6:45 am until 3:15 pm, when I wring myself out and go home. Incidentally, I have found that the preoperative visit is easier for the patient on the morning of surgery. I do not like the evenings-let the anesthesiologist visit then. I prefer the early morning, after the patient has slept (or not). The visit seems to work best the closer to the time of the operation, as the fears the patient may have will be closer to the surface. Increased anxiety also facilitates teaching and problem solving. The family is also more likely to be with the patient at that time and is given an opportunity to ask questions.
AORN Journal, July 1978, Vol28, No 1
Denise M Freeman, RN Santa Paula, Calif
29