- Email: [email protected]
How can we overcome barriers to preop interviews?
Opinions
How can we overcome barriers to preop interviews? “We’d like to do preoperative interviews with patients on the unit before they come to the OR, but we just can’t find the time. Moreover, patients usually aren’t in their rooms by 3 pm when our shift ends.” Do these words sound familiar? Many OR nurses find lack of time--or simply timing-a barrier to perioperative nursing. Four operating room nurses responded to the following questions: Have you solved these problems in your OR? If so, how did you do it? Or, can you think of ways that these problems might be overcome?
“Staff education and motivation are key issues‘”
This question is timely for us since we are now involved in developing a protocol for implementing preoperative interviews. The objection about “time to do them” is the one most often heard. Staff education and motivation are the key issues because we always manage to find the time to do things we consider most important. Some of our staff members have previous experience with preoperative interviews. They are fully convinced of both the need for the interviews and their contribution to better patient care. It is our intent to use these members of the staff fully as educators and implementors of our program. For staff education, we are compiling a list of pertinent journal articles and films that reinforce the need for and illustrate the mechanics of preoperative interviewing. We plan to have the journal articles available for everyone’s use. As we begin to implement our program, we are planning weekly meetings of all the staff to discuss problems, to anticipate further problems that may arise, and to offer possible solutions. To alleviate apprehension of staff members who have never before
dAORN Journal, April 1981, V o l 3 3 . N o 5
93 1
“We plan to use been involved in preoperative interviews, we plan to a buddy system.” use a “buddy system.” An inexperienced nurse would
visit a patient with a nurse proficient in interviewing techniques. In our situation, due to staffing and case load, there will be days when we may not be able to go to the nursing units. Our staffing also does not allow assigning one person to do all the preoperative interviews. On most days, however, at least one or two nurses will be free in the afternoon to see patients. Not until after one has done preoperative interviews, does one fully realize how much they can mean to both patient and nurse. The nurse is able to save valuable time in the operating room by preplanning her patients’ care and anticipating unusual needs. Alleviating fear makes the patient’s intraoperative and postoperative course smoother. A familiar face and knowledge of what to expect makes the operating room experience far less threatening.
Cecilia Gibbons, RN Operating room coordinator Veterans Administration Medical Center Nashville, Tenn
“saying we are short on staff is just an excuse.”
In our area, as in most areas of the country, there is a critical shortage of nurses and a financial crisis in most hospitals. Most operating rooms are low in staffing of nurses. We do not have enough nurses who can go to patient units. This is one of the problems that must be addressed. Whether we as operating room nurses should or should not do preoperative interviews is not in question. There are countless studies and articles on the subject. They have concluded that it is advantageous for us as operating room nurses to take the initiative to perform this important job. Since I have only worked in one hospital, I can only address this question relative to that operating room. I agree there is a shortage of nurses. Some days, we do not seem to have time for lunch. But there are rooms that will be finished before the end of our shift. These nurses can do some preoperative interviews or allow those of us interested in doing interviews to go see these patients. To do this, you must have the cooperation not only of the staff nurses but your supervisor as well. I must stress that saying we are too short on staff is just an excuse. There are days when it will be impossible to
AURN Journal, April 1981, Vol33, No 5
d935
“The more you visit visit patients, but these days are infrequent. patients, the I work primarily in the Neurosurgical Department. easier it becomes. The neurosurgical patient benefits from the preoperative assessment. There are so many new neurosurgical procedures that preoperative teaching is important. A good example is epidural and dorsal column stimulators. Hospitals that perform a number of these procedures are fortunate in having teaching films for their patients. But in our hospital, I teach these patients and reinforce what the physician has told him. These patients need a great deal of support from physicians, nurses, and family. Most patients are frightened of surgery, but the neuro patient is even more so. Reassuring this patient can be invaluable to both the patient and his family. The operating room nurse must want to do preoperative interviews. This may be one area operating room nurses lack in their education. The more times you visit patients, the easier it becomes to talk with them. I really believe that one of the main reasons we give excuses for not seeing patients is because of our own insecurities in dealing with patients as persons and not as cases. We must want to get involved and know how to deal with our own inadequacies. Operating room nurses must realize that patients need and want us to do preoperative interviews. You must educate yourselves so it can be done effectively. Both you and your patients will benefit.
Lynne Martha, RN, CNRN Neurosurgical nurse specialist Cooper Medical Center Camden, NJ
the staff is There are many innovative ways to ensure that not committed, the patient interviews are done. At our hospital, we have “/f
instituted a 9 am to 5:30 pm shift for our call
program personnel so they are available to see patients unless founder*” they are doing cases. They report the following morning on the patients they have interviewed. Our recovery room staff shows a film between 4 and 4:30pm each weekday that prepares the patients. Often the call nurse attends this group meeting, but she explains to the patients that she will talk privately with any who are interested. Other hospitals have hired a former operating room nurse part-time for patient interviews. Cards filled out by these nurses are left in the operating room for
938
AORN Journal, April 1981, V o l 3 3 , No 5
66
If f?LUSeS Want morning report so pertinent information reaches the to visit patients, circulating nurse who will be responsible for the they wi//find a way.” nursing care of those patients. It is not always
necessary that the interviewer be directly involved in the care of that particular patient, but it is imperative that the information reach the nurse who is involved with caring for that patient. Theoretically, the interview by the same nurse who will circulate for the case builds rapport between the nurse and her patient. Actually, heavy schedules do not allow this interaction. The other factor that ensures good patient interviews is the commitment of those involved. If the staff is not committed, the program will founder. If they are committed, hours could be staggered. Nurses could rotate, coming in an hour earlier for interviews or an hour later on a daily or weekly basis. If your nurses want to visit patients, they can figure out a way.
Marion L Cowden, RN, CNOR OR supervisor Veterans Administration Medical Center Phoenix, Ariz
As with any nursing specialty, the scope of operating room nurses has widened, giving them increasing responsibility over the years. With this increase in responsibility, less time is available for the one-to-one contact the nurse once enjoyed with the patient throughout their time in the operating room. To alleviate some of the patient’s fears and anxiety, it is important to let them see a familiar and friendly face in the cold, foreign atmosphere of the operating room. This can be accomplished through a preoperative interview to assess their problems and explain what they may expect during their perioperative period. To overcome the problem of lack of time and patients not having arrived in their room yet, a possible solution would be having the on-call nurses work an 8:30am to 5 pm shift so that, barring emergencies or an extremely busy schedule, they could do the preoperative interviewing between 4 and 5 pm. By this time, the anesthesiologist will have seen the patient, and the rigors of the admission routine will have passed. Patients will have had time to relax so they will be able to understand what the nurse is telling them. With this break-in time, they may be able to ask
dAORN Journal, April 1981, Vol33, N o 5
939
"/nterviewing will questions that have been worrying them. The nurse sharpen powers will also be able to ascertain the patient's knowledge of observation." of the pending surgery since the consent should be signed. If questions require the physician, the nurse can either let the staff nurse know or inform the physician about the questions the patient has posed. By having the on-call nurse interview the patients, all personnel will have an opportunity to participate in the interviewing process. This will sharpen their observation powers and aid them in finding ways of making surgery a little more pleasant through reassurance and having an informed patient.
Linda Cunningham, RN Patient teaching coordinator Garden State Community Hospital Marlton, NJ
School tests program for hospice nurses Students at the Catholic University of America (CUA) School of Nursing in Washington, DC, recently field tested a hospice nurse training program. Hospice is a specialized care program emphasizing the management of pain and other symptoms associated with terminal illness. One of its aims is to provide a caring environment for the family as well as the patient. CUA was awarded the contract to test the curriculum through the continuing education program from HCS, Inc. a management, consulting, and training firm that specializes in health and human resources, and the Health Resources Administration, Division of Nursing (HRA), part of the US Department of Health and Human Services. Until the curriculum was developed by these organizations, no formal program existed to prepare nurses for hospice work. "This is the first time that someone has looked at both the patients' needs holistically and the needs of individuals working in hospices and integrated them into a conceptual model of education," said Judith Hogan. director of continuing education for the School of Nursing and a member of the national advisory board for the contract. "There has never been a formal
942
educational program to prepare nurses to work in the stressful environment of a hospice. Nurses have been educated to care for patients who are going to get well. In this instance, they have to learn to care for clients for whom there is no cure. They have to comfort, rather than cure." The curriculum for the field test emphasized interdisciplinary team concepts; communication concepts including death and dying, pain control, palliative treatment, and ethical or spiritual issues; family dynamics; management of stress; and humanistic patient care concepts. The curriculum was evaluated by the students each day during the field testing. Participantswere asked if the information would meet their needs-was the content relevant, did they need additional materials? One of the strengths of the curriculum is that it is flexible, Hogan said. It can be used by a nursing school, as continuing education for nurses, or as training for new staff members. Participants suggested the curriculum would be stronger if time were spent practicing classroom skills in a hospice setting. The curriculum currently is being reevaluated by HCS, Inc, and HRA. The process will take approximately six months.
AORN Journal, April 1981, V o l 3 3 , No 5
How can we overcome barriers to preop interviews? “We’d like to do preoperative interviews with patients on the unit before they come to the OR, but we just can’t find the time. Moreover, patients usually aren’t in their rooms by 3 pm when our shift ends.” Do these words sound familiar? Many OR nurses find lack of time--or simply timing-a barrier to perioperative nursing. Four operating room nurses responded to the following questions: Have you solved these problems in your OR? If so, how did you do it? Or, can you think of ways that these problems might be overcome?
“Staff education and motivation are key issues‘”
This question is timely for us since we are now involved in developing a protocol for implementing preoperative interviews. The objection about “time to do them” is the one most often heard. Staff education and motivation are the key issues because we always manage to find the time to do things we consider most important. Some of our staff members have previous experience with preoperative interviews. They are fully convinced of both the need for the interviews and their contribution to better patient care. It is our intent to use these members of the staff fully as educators and implementors of our program. For staff education, we are compiling a list of pertinent journal articles and films that reinforce the need for and illustrate the mechanics of preoperative interviewing. We plan to have the journal articles available for everyone’s use. As we begin to implement our program, we are planning weekly meetings of all the staff to discuss problems, to anticipate further problems that may arise, and to offer possible solutions. To alleviate apprehension of staff members who have never before
dAORN Journal, April 1981, V o l 3 3 . N o 5
93 1
“We plan to use been involved in preoperative interviews, we plan to a buddy system.” use a “buddy system.” An inexperienced nurse would
visit a patient with a nurse proficient in interviewing techniques. In our situation, due to staffing and case load, there will be days when we may not be able to go to the nursing units. Our staffing also does not allow assigning one person to do all the preoperative interviews. On most days, however, at least one or two nurses will be free in the afternoon to see patients. Not until after one has done preoperative interviews, does one fully realize how much they can mean to both patient and nurse. The nurse is able to save valuable time in the operating room by preplanning her patients’ care and anticipating unusual needs. Alleviating fear makes the patient’s intraoperative and postoperative course smoother. A familiar face and knowledge of what to expect makes the operating room experience far less threatening.
Cecilia Gibbons, RN Operating room coordinator Veterans Administration Medical Center Nashville, Tenn
“saying we are short on staff is just an excuse.”
In our area, as in most areas of the country, there is a critical shortage of nurses and a financial crisis in most hospitals. Most operating rooms are low in staffing of nurses. We do not have enough nurses who can go to patient units. This is one of the problems that must be addressed. Whether we as operating room nurses should or should not do preoperative interviews is not in question. There are countless studies and articles on the subject. They have concluded that it is advantageous for us as operating room nurses to take the initiative to perform this important job. Since I have only worked in one hospital, I can only address this question relative to that operating room. I agree there is a shortage of nurses. Some days, we do not seem to have time for lunch. But there are rooms that will be finished before the end of our shift. These nurses can do some preoperative interviews or allow those of us interested in doing interviews to go see these patients. To do this, you must have the cooperation not only of the staff nurses but your supervisor as well. I must stress that saying we are too short on staff is just an excuse. There are days when it will be impossible to
AURN Journal, April 1981, Vol33, No 5
d935
“The more you visit visit patients, but these days are infrequent. patients, the I work primarily in the Neurosurgical Department. easier it becomes. The neurosurgical patient benefits from the preoperative assessment. There are so many new neurosurgical procedures that preoperative teaching is important. A good example is epidural and dorsal column stimulators. Hospitals that perform a number of these procedures are fortunate in having teaching films for their patients. But in our hospital, I teach these patients and reinforce what the physician has told him. These patients need a great deal of support from physicians, nurses, and family. Most patients are frightened of surgery, but the neuro patient is even more so. Reassuring this patient can be invaluable to both the patient and his family. The operating room nurse must want to do preoperative interviews. This may be one area operating room nurses lack in their education. The more times you visit patients, the easier it becomes to talk with them. I really believe that one of the main reasons we give excuses for not seeing patients is because of our own insecurities in dealing with patients as persons and not as cases. We must want to get involved and know how to deal with our own inadequacies. Operating room nurses must realize that patients need and want us to do preoperative interviews. You must educate yourselves so it can be done effectively. Both you and your patients will benefit.
Lynne Martha, RN, CNRN Neurosurgical nurse specialist Cooper Medical Center Camden, NJ
the staff is There are many innovative ways to ensure that not committed, the patient interviews are done. At our hospital, we have “/f
instituted a 9 am to 5:30 pm shift for our call
program personnel so they are available to see patients unless founder*” they are doing cases. They report the following morning on the patients they have interviewed. Our recovery room staff shows a film between 4 and 4:30pm each weekday that prepares the patients. Often the call nurse attends this group meeting, but she explains to the patients that she will talk privately with any who are interested. Other hospitals have hired a former operating room nurse part-time for patient interviews. Cards filled out by these nurses are left in the operating room for
938
AORN Journal, April 1981, V o l 3 3 , No 5
66
If f?LUSeS Want morning report so pertinent information reaches the to visit patients, circulating nurse who will be responsible for the they wi//find a way.” nursing care of those patients. It is not always
necessary that the interviewer be directly involved in the care of that particular patient, but it is imperative that the information reach the nurse who is involved with caring for that patient. Theoretically, the interview by the same nurse who will circulate for the case builds rapport between the nurse and her patient. Actually, heavy schedules do not allow this interaction. The other factor that ensures good patient interviews is the commitment of those involved. If the staff is not committed, the program will founder. If they are committed, hours could be staggered. Nurses could rotate, coming in an hour earlier for interviews or an hour later on a daily or weekly basis. If your nurses want to visit patients, they can figure out a way.
Marion L Cowden, RN, CNOR OR supervisor Veterans Administration Medical Center Phoenix, Ariz
As with any nursing specialty, the scope of operating room nurses has widened, giving them increasing responsibility over the years. With this increase in responsibility, less time is available for the one-to-one contact the nurse once enjoyed with the patient throughout their time in the operating room. To alleviate some of the patient’s fears and anxiety, it is important to let them see a familiar and friendly face in the cold, foreign atmosphere of the operating room. This can be accomplished through a preoperative interview to assess their problems and explain what they may expect during their perioperative period. To overcome the problem of lack of time and patients not having arrived in their room yet, a possible solution would be having the on-call nurses work an 8:30am to 5 pm shift so that, barring emergencies or an extremely busy schedule, they could do the preoperative interviewing between 4 and 5 pm. By this time, the anesthesiologist will have seen the patient, and the rigors of the admission routine will have passed. Patients will have had time to relax so they will be able to understand what the nurse is telling them. With this break-in time, they may be able to ask
dAORN Journal, April 1981, Vol33, N o 5
939
"/nterviewing will questions that have been worrying them. The nurse sharpen powers will also be able to ascertain the patient's knowledge of observation." of the pending surgery since the consent should be signed. If questions require the physician, the nurse can either let the staff nurse know or inform the physician about the questions the patient has posed. By having the on-call nurse interview the patients, all personnel will have an opportunity to participate in the interviewing process. This will sharpen their observation powers and aid them in finding ways of making surgery a little more pleasant through reassurance and having an informed patient.
Linda Cunningham, RN Patient teaching coordinator Garden State Community Hospital Marlton, NJ
School tests program for hospice nurses Students at the Catholic University of America (CUA) School of Nursing in Washington, DC, recently field tested a hospice nurse training program. Hospice is a specialized care program emphasizing the management of pain and other symptoms associated with terminal illness. One of its aims is to provide a caring environment for the family as well as the patient. CUA was awarded the contract to test the curriculum through the continuing education program from HCS, Inc. a management, consulting, and training firm that specializes in health and human resources, and the Health Resources Administration, Division of Nursing (HRA), part of the US Department of Health and Human Services. Until the curriculum was developed by these organizations, no formal program existed to prepare nurses for hospice work. "This is the first time that someone has looked at both the patients' needs holistically and the needs of individuals working in hospices and integrated them into a conceptual model of education," said Judith Hogan. director of continuing education for the School of Nursing and a member of the national advisory board for the contract. "There has never been a formal
942
educational program to prepare nurses to work in the stressful environment of a hospice. Nurses have been educated to care for patients who are going to get well. In this instance, they have to learn to care for clients for whom there is no cure. They have to comfort, rather than cure." The curriculum for the field test emphasized interdisciplinary team concepts; communication concepts including death and dying, pain control, palliative treatment, and ethical or spiritual issues; family dynamics; management of stress; and humanistic patient care concepts. The curriculum was evaluated by the students each day during the field testing. Participantswere asked if the information would meet their needs-was the content relevant, did they need additional materials? One of the strengths of the curriculum is that it is flexible, Hogan said. It can be used by a nursing school, as continuing education for nurses, or as training for new staff members. Participants suggested the curriculum would be stronger if time were spent practicing classroom skills in a hospice setting. The curriculum currently is being reevaluated by HCS, Inc, and HRA. The process will take approximately six months.
AORN Journal, April 1981, V o l 3 3 , No 5